OrganizationActive
Multnomah County
NPI 1023451044 · State or Local Public Health Clinic/Center · Portland, OR
Provider details
- NPI number
- 1023451044
- Entity type
- Organization
- Primary specialty
- State or Local Public Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Derrick Moten, Interim Business Services Director(503) 988-2966
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
619 Nw 6th Ave
Portland, OR 97209-3964
Phone: (503) 988-7468
Fax: (503) 988-3015
Approximate (ZIP-level) locationGet directions
Mailing address
619 Nw 6th Ave
Portland, OR 97209-3964
Other names (DBA / former)
- Doing business as
- Vaccine Depot
- Doing business as
- Vaccine Depot
Registry dates
- Enumerated
- 2013-04-09
- Last updated
- 2024-05-18
- Certified
- 2024-05-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.