Organization · Type 2 NPI

Kaiser Foundation Health Plan of the Northwest

General Practice Physician · Portland, OR

NPI number 1104378140 Active

Practice location

12100 SE Stevens Ct, Suite 106
Portland, OR 97086-4707

Call (800) 813-2000 Map

Fax (503) 286-6879

Mailing address

500 NE Multnomah St
Portland, OR 97232-2023

Specialties and licenses

Taxonomy	Code	License
Optometrist	152W00000X	None listed
Technician/Technologist	156F00000X	None listed
General Practice Physician Primary	208D00000X	None listed

General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

12 other providers at this address

Other general practice physician providers in Portland

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NPI record

NPI: 1104378140
Entity type: Organization (Type 2)
Issued: Oct 25, 2016
Last updated: Jun 1, 2021
Status: Active
Subpart: Yes of Kaiser Foundation Health Plan of the Northwest

Other names

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Clackamas Eye Care · other name
Clackamas Eye Care · other name

Authorized official

Stephen Shawn Barton
Executive Director, Revenue Cycle
(503) 813-2440

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104378140

Kaiser Foundation Health Plan of the Northwest's National Provider Identifier is 1104378140, issued on Oct 25, 2016. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Portland, OR. The record was last updated on Jun 1, 2021.