NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Integrative Medicine Bridgeport

  • Clinic/Center
  • Tigard, OR
National Provider Identifier
1245549724
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Integrative Medicine Bridgeport
Practice address
18040 SW Lower Boones Ferry Rd
Suite 207
Tigard, OR 97224-7259
Phone
(503) 215-5340
NPI assigned
Sep 30, 2010
Last updated
Nov 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dennis Noonan
Title
Administration
Phone
(503) 216-4657

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

18040 SW Lower Boones Ferry Rd
Suite 207
Tigard, OR 97224-7259

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other names 1

  • PROVIDENCE INTEGRATIVE MEDICINE BRIDGEPORT Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Service-9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1245549724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18040 SW LOWER BOONES FERRY RD",
            "address_2": "SUITE 207",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247259",
            "telephone_number": "503-215-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "NOONAN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "503-216-4657"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE INTEGRATIVE MEDICINE BRIDGEPORT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.