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17882 Se Mcloughlin Blvd Milwaukie OR 97267-6103 | |
| (503) 353-9415 | |
| (503) 353-9409 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 17882 Se Mcloughlin Blvd, Milwaukie, Oregon |
| Authorized Official Name and Position | Patricia A. Ewing (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5033539415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
17882 Se Mcloughlin Blvd Milwaukie OR 97267-6103 Ph: (503) 353-9415 | 17882 Se Mcloughlin Blvd Milwaukie OR 97267-6103 Ph: (503) 353-9415 |
| NPI Number | 1366506073 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 02/10/2021 |
| Certification Date | 02/10/2021 |
| Medicare PECOS PAC ID | 3375949449 |
|---|---|
| Medicare Enrollment ID | O20210915001853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366506073 | NPI | - | NPPES |
| 292910 | Medicaid | OR |
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