| NPI | 1508741190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANASTASIA HAMILTON Payer Enrollment Specialist 971-438-1838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |