NPIMap

Organization Active NPI

George I. Hannibal

  • Community/Behavioral Health Agency
  • Portland, OR
National Provider Identifier
1578847737
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
L525 Issued in OR
Legal business name
GEORGE I. HANNIBAL
Practice address
1419 NE 69TH Ave
Portland, OR 97213-5301
Phone
(503) 254-1545
Fax
(503) 525-2846
NPI assigned
Oct 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Authorized official

Name
George Ivar. Hannibal, LCSWNPI 1003866708
Title
Owner/Operator
Phone
(503) 254-1545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X L525 OR Primary

Addresses

Primary practice location

1419 NE 69TH Ave
Portland, OR 97213-5301

Mailing address

1419 NE 69TH Ave
Portland, OR 97213-5301
Phone (503) 254-1545

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1578847737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 NE 69TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135301",
            "telephone_number": "503-254-1545",
            "fax_number": "503-525-2846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 NE 69TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135301",
            "telephone_number": "503-254-1545",
            "fax_number": "503-525-2846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE I. HANNIBAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "HANNIBAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "IVAR.",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "503-254-1545",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "L525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.