| Providence Medical Group | |
|
9427 Sw Barnes Rd Ste 395 Portland OR 97225-6652 | |
| (503) 216-1280 | |
| (503) 216-1288 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Clinic/center |
| Location | 9427 Sw Barnes Rd Ste 395, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/AVP REIMBUR) |
| 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 9427 Sw Barnes Rd Ste 395 Portland OR 97225-6652 Ph: (503) 216-1280 |
| NPI Number | 1316125149 |
|---|---|
| Provider Enumeration Date | 02/04/2008 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316125149 | NPI | - | NPPES |
| 279056 | Medicaid | OR |
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