Organization
WELLSPRING
Active
Organization
WELLSPRING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA HUMPHREY-KEEVER (CFO)
(503) 963-7786
Entity
Organization
Contact information
Practice address
2034 SE 6TH AVE, PORTLAND, OR 97214-4510
(503) 238-6801
(503) 238-6810
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
(503) 552-6211
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223347
—
OR
05
—
226398
—
OR
Enumeration date
02/05/2007
Last updated
08/22/2020
Update your record
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