| Providence Neurological Specialties Psv Mjp | |
|
9427 Sw Barnes Rd Suite 595 Portland OR 97225-6640 | |
| (503) 216-1150 | |
| (503) 216-1066 |
| Full Name | Providence Neurological Specialties Psv Mjp |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 9427 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANDT SECRETARY ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Neurological Specialties Psv Mjp Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Neurological Specialties Psv Mjp 9427 Sw Barnes Rd Suite 595 Portland OR 97225-6640 Ph: (503) 216-1150 |
| NPI Number | 1699804336 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 09/29/2024 |
| Certification Date | 09/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699804336 | NPI | - | NPPES |
| 213812 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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