| Coda, Inc. | |
|
1027 E Burnside St Portland OR 97214-1328 | |
| (503) 239-8400 | |
| (503) 239-8407 |
| Full Name | Coda, Inc. |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1027 E Burnside St, Portland, Oregon |
| Authorized Official Name and Position | Timothy T. Hartnett (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5032398400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coda, Inc. 1027 E Burnside St Portland OR 97214-1328 Ph: (503) 239-8400 | Coda, Inc. 1027 E Burnside St Portland OR 97214-1328 Ph: (503) 239-8400 |
| NPI Number | 1437213865 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 4082886908 |
|---|---|
| Medicare Enrollment ID | O20111018000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437213865 | NPI | - | NPPES |
| 154948 | Medicaid | OR | |
| 028144 | Medicaid | OR |
| Provider Name | Thomas T Meyer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043343353 PECOS PAC ID: 2365457793 Enrollment ID: I20101222000692 |
| Provider Name | Eve L Klein |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982846234 PECOS PAC ID: 6103096029 Enrollment ID: I20110920000863 |
| Provider Name | Andrea Gough-goldman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013273861 PECOS PAC ID: 7416254420 Enrollment ID: I20160317002392 |
| Provider Name | Sheena Munson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205357183 PECOS PAC ID: 0547532566 Enrollment ID: I20200123003084 |
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