| Providence Medical Group Milwaukie Family Medicine | |
|
10330 Se 32nd Ave Suite 205 Milwaukie OR 97222-6594 | |
| (503) 513-8950 | |
| (503) 513-8951 |
| Full Name | Providence Medical Group Milwaukie Family Medicine |
|---|---|
| Speciality | Clinic/center |
| Location | 10330 Se 32nd Ave, Milwaukie, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Milwaukie Family Medicine Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Milwaukie Family Medicine 10330 Se 32nd Ave Suite 205 Milwaukie OR 97222-6594 Ph: (503) 513-8950 |
| NPI Number | 1699870873 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 09/24/2020 |
| Certification Date | 09/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699870873 | NPI | - | NPPES |
| 022861 | Medicaid | OR |
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