Organization
OPTUMCARE PORTLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA CASTILLO (REVENUE CYCLE MANAGER)
(503) 384-2027
Entity
Organization
Contact information
Practice address
9450 SW BARNES RD STE 100, PORTLAND, OR 97225
(503) 292-9560
(503) 292-9510
Mailing address
9450 SW BARNES RD STE 100, PORTLAND, OR 97225-6642
(503) 292-9560
(503) 292-9510
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810029000
REGENCE BLUE CROSS
OR
01
—
DA6538
MEDICARE RAILROAD GROUP
OR
Enumeration date
03/21/2007
Last updated
12/05/2022
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