Provider Demographics
NPI:1871747659
Name:COLUMBIA LUTHERAN CHARITIES
Entity type:Organization
Organization Name:COLUMBIA LUTHERAN CHARITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-4321
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:503-338-7585
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:SUITE 270
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-325-4321
Practice Address - Fax:503-338-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR381320Medicare Oscar/Certification