| Providence Medical Group | |
|
4104 Se 82nd Ave Suite 250 Portland OR 97266-2954 | |
| (503) 215-9850 | |
| (503) 215-9855 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 4104 Se 82nd Ave, 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: () - | Providence Medical Group 4104 Se 82nd Ave Suite 250 Portland OR 97266-2954 Ph: (503) 215-9850 |
| NPI Number | 1679678866 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679678866 | NPI | - | NPPES |
| 022860 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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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 | |
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