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10330 Se 32nd Ave Suite 226 Milwaukie OR 97222-6699 | |
| (503) 513-8020 | |
| (503) 513-8025 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 10330 Se 32nd Ave, Milwaukie, Oregon |
| Authorized Official Name and Position | Keenan B Freeman (CFO) |
| Authorized Official Contact | 5038936524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3158 Portland OR 97208-3158 Ph: () - | 10330 Se 32nd Ave Suite 226 Milwaukie OR 97222-6699 Ph: (503) 513-8020 |
| NPI Number | 1952586869 |
|---|---|
| Provider Enumeration Date | 01/09/2008 |
| Last Update Date | 08/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952586869 | NPI | - | NPPES |
| 213813 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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