Organization
PROVIDENCE PORTLAND MEDICAL CENTER
Active
Parent organization
PROVIDENCE PORTLAND MEDICAL CENTER
Other names
PROVIDENCE INTEGRATIVE MEDICINE EAST
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE PORTLAND MEDICAL CENTER
Authorized official
WILLIAM OLSON (CHIEF FINANCIAL OFFICER)
(503) 215-7384
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST, 1ST FLOOR, PORTLAND, OR 97213-2933
(503) 215-6503
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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