| Columbia River Correctional Facility | |
|
9111 Ne Sunderland Rd Portland OR 97211-1708 | |
| (503) 280-6646 | |
| (503) 280-6081 |
| Full Name | Columbia River Correctional Facility |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 9111 Ne Sunderland Rd, Portland, Oregon |
| Authorized Official Name and Position | Enrique Sama (VP, HUMAN RESOURCES) |
| Authorized Official Contact | 5039637791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia River Correctional Facility Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Columbia River Correctional Facility 9111 Ne Sunderland Rd Portland OR 97211-1708 Ph: (503) 280-6646 |
| NPI Number | 1942349147 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942349147 | NPI | - | NPPES |
| 226398 | Medicaid | OR | |
| 223347 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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