Provider Demographics
NPI:1881718443
Name:PORTLAND VA MEDICAL CENTER
Entity type:Organization
Organization Name:PORTLAND VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:X-RAY TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:JOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:AART
Authorized Official - Phone:360-690-1824
Mailing Address - Street 1:7800 NE 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2897
Mailing Address - Country:US
Mailing Address - Phone:360-891-2719
Mailing Address - Fax:
Practice Address - Street 1:7800 NE 86TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2897
Practice Address - Country:US
Practice Address - Phone:360-891-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital