Gundersen, Mark
Gundersen, Mark is an individual health care provider with primary practice located at 105 S 3Rd St , Saint Helens OR 97051-2009. He recently has only one registered license in Other Service Providers / Case Manager/Care Coordinator, which is considered as his primary health care specialty. Gundersen, Mark can be contacted via phone (503) 397-6900.Contact Information
Primary practice address
105 S 3Rd St
Saint Helens OR 97051-2009
Phone: (503) 397-6900
Fax: (503) 397-5373
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Case Manager/Care Coordinator | 171M00000X | Oregon |
Profile Details
| NPI number | 1154745800 |
|---|---|
| LBN Legal business name | Gundersen, Mark |
| Credentials | QMHA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 14th, 2014 |
| Last updated | Feb 14th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154745800 | NPPES |
| Oregon | MEDICAID | 123190 |
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