PORTLAND VAMC (NPI# 1639722275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639722275 |
| Entity Type | Organization |
| Organization Name | PORTLAND VAMC |
| Practice Address |
4422 Ne Devils Lake Blvd Ste 2 Lincoln City OR 97367-5000 |
| Mailing Address |
Po Box 94414 Cleveland OH 44101-4414 |
| Practice Telephone | 7023413164 |
| Practice Fax Number | 7023413503 |
| Mailing Telephone | 7023413164 |
| Mailing Fax Number | 7023413503 |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2019-07-23 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM LEAD) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| LINCOLN CITY VA CLINIC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346657491 | Portland Vamc | Clinic/Center | 308 Sw 1st Ave, Suite 155, Portland, OR 97204-3400 | 2014-07-21 |
| 1104233295 | Portland Vamc | Clinic/Center | 704 Veterans Drive, The Dalles, OR 97058-9998 | 2014-07-21 |
| 1114151248 | Portland Vamc | Clinic/Center | 1925 Ne Stucki Ave Ste 300, Hillsboro, OR 97006-6945 | 2009-05-04 |
| 1710174974 | Portland Vamc | Clinic/Center | 1800 Ne Market Drive, Fairview, OR 97024-9998 | 2007-10-01 |
| 1720022940 | Portland Vamc | Clinic/Center | 91400 S Neacoxie Blvd, Building 7315, Warrenton, OR 97146-7267 | 2006-06-16 |
| 1376581371 | Portland Vamc | Clinic/Center | 1750 Mcgilchrist St Se, Suite 130, Salem, OR 97302-1691 | 2006-06-02 |
| 1184675803 | Portland Vamc | Clinic/Center | 2650 Ne Courtney Dr, Bend, OR 97701-7636 | 2006-05-15 |
| 1497162556 | Portland Vamc | Clinic/Center | 1010 Sw Coast Hwy, Newport, OR 97365-5288 | 2014-07-21 |
| 1982957510 | Portland Vamc | Clinic/Center | 1750 Blankenship Rd, Suite 300, West Linn, OR 97068-5101 | 2012-10-19 |
| 1255424685 | Portland Vamc | Department of Veterans Affairs (VA) Pharmacy | 1601 E 4th Plain Blvd, Vancouver, WA 98661-3713 | 2006-09-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PORTLAND VAMC | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97207-2964 |
| Street Address |
4422 NE DEVILS LAKE BLVD STE 2 |
| City | LINCOLN CITY |
| State | OR |
| Zip Code | 97367-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184742454 | Brenda Mcallister | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2007-03-26 |
| 1548887854 | Dawn Lori Barr | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2020-07-02 |
| 1992335582 | Nathan Andrew Fingerson | Counselor | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2020-01-22 |
| 1588131288 | Stephanie Marie Arnoldussen | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2018-10-31 |
| 1013496777 | Michelle M Schuller | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2018-08-13 |
| 1104304344 | Heidi Louise Harrington | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367 | 2018-07-31 |
| 1477074011 | Mary Jo Koschel | Registered Nurse | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2017-07-05 |
| 1356727523 | Adam Lee Swart | Counselor | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367 | 2015-08-10 |
| 1568846178 | Amron Celeste Galloway | Counselor | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2015-07-13 |
| 1811374846 | Adriana Elizabeth Larsen De Gisler | Counselor | 4422 Ne Devils Lake Blvd Ste 2, Lincoln City, OR 97367-5000 | 2015-04-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881256121 | Amanda Suzanne Cherryholmes | Peer Specialist | 1206 Se 48th Place, Montgomery, Lincoln City, OR 97367 | 2019-07-08 |
| 1982198719 | Lakeside Family Dentistry | Dentist | 3173 Ne West Devils Lake Rd., Lincoln City, OR 97367 | 2018-06-15 |
| 1891282117 | Mark J Lee | Marriage & Family Therapist | 412 Southwest Highway 101, Lincoln City, OR 97367 | 2018-04-23 |
| 1508130196 | Michelle Marie Becker | Pharmacist | 1030 Se Oar Ave Bi-mart, Lincoln City, OR 97367 | 2012-02-29 |
| 1457651465 | Laurene Norelle Alcocer | Pharmacist | 4048 Ne Hwy 101, Lincoln City, OR 97367 | 2010-10-25 |
| 1518106228 | Estate of Kevin L. Chancellor | Dentist | 3173 Ne West Devils Lake Rd, Lincoln City, OR 97367 | 2009-02-19 |
| 1346403656 | Lincoln City Pharmacy & Gifts | Pharmacy | 1800 Se Hwy 101, Suite C, Lincoln City, OR 97367 | 2008-07-07 |
| 1841487139 | Assisted Living Concepts Inc | Assisted Living Facility | 1400 Se 19th, Lincoln City, OR 97367 | 2007-10-01 |
| 1376741074 | Frank Wesley Nettleship | Dentist | 9101 Keys Place, Lincoln City, OR 97367 | 2007-07-05 |
| 1306043989 | Julie Anne Bass | Case Manager/Care Coordinator | 4402 Devils Lake Blvd #2, Lincoln City, OR 97367 | 2007-06-28 |
| Find all providers in zip 97367 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841714607 | Roseburg Vamc | Clinic/Center | 211 E 7th Ave Ste 220, Eugene, OR 97401-2722 | 2017-08-02 |
| 1457742538 | Walla Walla Vamc | Clinic/Center | 2 Marine Drive, Suite 103, Boardman, OR 97818-9998 | 2015-02-11 |
| 1710378898 | Walla Walla Vamc | Clinic/Center | 401 Northeast 1st Street, Suite A, Enterprise, OR 97828-1186 | 2015-02-11 |
| 1346657491 | Portland Vamc | Clinic/Center | 308 Sw 1st Ave, Suite 155, Portland, OR 97204-3400 | 2014-07-21 |
| 1104233295 | Portland Vamc | Clinic/Center | 704 Veterans Drive, The Dalles, OR 97058-9998 | 2014-07-21 |
| 1548677602 | Boise Vamc | Clinic/Center | 635 Highway 20 N Ste 4, Hines, OR 97738-9462 | 2014-07-21 |
| 1790038339 | White City Vamc | Clinic/Center | 1877 Williams Highway, Grants Pass, OR 97527 | 2012-10-19 |
| 1114151248 | Portland Vamc | Clinic/Center | 1925 Ne Stucki Ave Ste 300, Hillsboro, OR 97006-6945 | 2009-05-04 |
| 1184812943 | Walla Walla Vamc | Clinic/Center | 202 12th St, La Grande, OR 97850-2879 | 2007-10-05 |
| 1710174974 | Portland Vamc | Clinic/Center | 1800 Ne Market Drive, Fairview, OR 97024-9998 | 2007-10-01 |
| Find all providers with the same taxonomy | ||||
| City | LINCOLN CITY |
| Zip Code | 97367 |
Please comment or provide details below to improve the information on PORTLAND VAMC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.