POHALA CLINIC PC NPI 1689025231

NPI Information

NPI: 1689025231
Provider Name: POHALA CLINIC PC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 38D1065369

Address:
7477 SE 52ND AVE
PORTLAND, OR
ZIP 97206
Phone: (503) 572-4196
Get Directions

POHALA CLINIC PC is a family nurse practitioner in Portland, OR. POHALA CLINIC PC NPI is 1689025231. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

7477 SE 52ND AVE
PORTLAND, OR
ZIP 97206-206
Phone: (503) 572-4196
Fax: (855) 420-5847

The provider's authorized official is Becky R Copenhagen .
The authorized official title is Office Manager and has the following contact phone number (503) 572-4196.

The CLIA number assigned to this NPI record is 38D1065369 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2016 and was last updated on 5/12/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	175F00000X	Naturopath			OREGON	No
2	363LF0000X	Nurse Practitioner	Family	200150144NP	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	R154680	MEDICARE PIN	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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