| Providence Medical Group | |
|
4400 Ne Halsey St, Bldg 2 Ste 599 Portland OR 97213-9721 | |
| (503) 215-2110 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Addiction Psychiatry |
| Location | 4400 Ne Halsey St, Bldg 2, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group 4400 Ne Halsey St, Bldg 2 Ste 599 Portland OR 97213-9721 Ph: (503) 215-2110 |
| NPI Number | 1033804091 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 04/04/2024 |
| Certification Date | 04/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033804091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | (* (Not Available)) | Primary |
Sandra M. Gonzalez Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 Sw Morrison St, Suite 411, Portland, OR 97205 Phone: 503-228-0939 Fax: 503-226-8069 | |
Cascadia Behavioral Healthcare, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9125 Sw 55th Ave, Portland, OR 97219 Phone: 503-238-0769 Fax: 503-477-4598 | |
Edwards Psychotherapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1220 Sw Morrison St, Suite 1100, Portland, OR 97205 Phone: 503-222-0557 | |
Wellpath Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3701 Se Milwaukie Ave Ste D, Portland, OR 97202 Phone: 503-784-2377 | |
Daniel C Donohue, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2931 Ne Broadway St, Portland, OR 97232 Phone: 503-819-2515 | |
Cultivating A New Life Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Se Spokane St Ste 300, Portland, OR 97202 Phone: 541-904-0468 | |
Tiffany Kettermann, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2926 Ne Flanders St Ste 3c, Portland, OR 97232 Phone: 971-270-0167 |