| Providence Medical Group | |
|
9155 Sw Barnes Rd Ste 416 Portland OR 97225-6631 | |
| (503) 216-1150 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 9155 Sw Barnes Rd Ste 416, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (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 Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group 9155 Sw Barnes Rd Ste 416 Portland OR 97225-6631 Ph: (503) 216-1150 |
| NPI Number | 1184957821 |
|---|---|
| Provider Enumeration Date | 09/14/2009 |
| Last Update Date | 07/19/2024 |
| Certification Date | 07/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184957821 | NPI | - | NPPES |
| 500612019 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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