Organization
KAISER FOUNDATION HEALTH PLAN
Active
Parent organization
KAISER FOUNDATION HEALTH PLAN
Other names
Central Interstate Medical Office
Organization subpart
Yes
Provider details
NPI number
Legal business name
KAISER FOUNDATION HEALTH PLAN
Authorized official
STEPHEN SHAWN BARTON (EXECUTIVE DIRECTOR, REVENUE CYCLE)
(503) 813-2440
Entity
Organization
Contact information
Practice address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 528-7458
Mailing address
500 NE MULTNOMAH ST, PORTLAND, OR 97232-2023
(503) 813-4939
(503) 813-4967
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119040
MAM CERTIFICATION
OR
Enumeration date
10/19/2009
Last updated
06/01/2021
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