Organization
MULTNOMAH COUNTY
Active
Other names
MC REYNOLDS SBHC
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BARDI (PROGRAM SUPERVISOR)
(503) 988-9756
Entity
Organization
Contact information
Practice address
1698 SW CHERRY PARK RD, TROUTDALE, OR 97060-1481
(503) 988-3340
(503) 988-4464
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
(503) 988-3340
(503) 988-4464
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
11/08/2019
Last updated
11/08/2019
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