| Charles G Bellville Sole Mbr | |
|
909 Sw Saint Clair Ave Portland OR 97205-1300 | |
| (503) 274-2661 | |
| (503) 692-0688 |
| Full Name | Charles G Bellville Sole Mbr |
|---|---|
| Speciality | Clinic/Center |
| Location | 909 Sw Saint Clair Ave, Portland, Oregon |
| Authorized Official Name and Position | Charles George Bellville (0WNER) |
| Authorized Official Contact | 5032742661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles G Bellville Sole Mbr 909 Sw Saint Clair Ave Portland OR 97205-1300 Ph: (503) 274-2661 | Charles G Bellville Sole Mbr 909 Sw Saint Clair Ave Portland OR 97205-1300 Ph: (503) 274-2661 |
| NPI Number | 1487931382 |
|---|---|
| Provider Enumeration Date | 11/08/2011 |
| Last Update Date | 08/16/2013 |
| Medicare PECOS PAC ID | 2365672987 |
|---|---|
| Medicare Enrollment ID | O20140227001173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487931382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 11983 (Oregon) | Primary |
| Provider Name | Charles G Bellville |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598734618 PECOS PAC ID: 6305737594 Enrollment ID: I20040324001665 |
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