Organization
MULTNOMAH COUNTY
Active
Other names
Multnomah County Health Dept, Southeast
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK MOTEN (INTERIM BUSINESS SERVICES DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
3653 SE 34TH AVE, PORTLAND, OR 97202-3034
(503) 988-7462
(503) 988-3015
Mailing address
619 NW 6TH AVE STE 500, PORTLAND, OR 97209-3964
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
OR
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
Enumeration date
02/02/2007
Last updated
05/18/2024
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