Organization
CLACKAMAS COUNTY
Active
Other names
Sunnyside Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ED JOHNSON (CFO)
(503) 742-5325
Entity
Organization
Contact information
Practice address
9775 SE SUNNYSIDE RD STE 200, CLACKAMAS, OR 97015-5721
(503) 794-3830
(503) 794-3850
Mailing address
2051 KAEN RD STE 367, OREGON CITY, OR 97045-4035
(503) 742-5300
(503) 655-8350
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022710
—
OR
05
—
031799
—
OR
05
—
131607
—
OR
05
—
500653393
—
OR
Enumeration date
08/14/2012
Last updated
09/24/2019
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