Provider Demographics
NPI:1649712571
Name:CENTER OF EXCELLENCE IN CO-OCCURRING MEDICINE
Entity type:Organization
Organization Name:CENTER OF EXCELLENCE IN CO-OCCURRING MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-620-8170
Mailing Address - Street 1:12655 SW CENTER ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1864
Mailing Address - Country:US
Mailing Address - Phone:888-418-2993
Mailing Address - Fax:888-418-2994
Practice Address - Street 1:3570 SW RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4534
Practice Address - Country:US
Practice Address - Phone:888-418-2993
Practice Address - Fax:888-418-2994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMAS LIMITED/PSYCHIATRIST ON-CALL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1650762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty