| Providence Psychiatry East | |
|
5251 Ne Glisan St Bldg A, 2nd Floor Portland OR 97213-3052 | |
| (503) 215-4860 | |
| Not Available |
| Full Name | Providence Psychiatry East |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 5251 Ne Glisan St, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Psychiatry East Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Psychiatry East 5251 Ne Glisan St Bldg A, 2nd Floor Portland OR 97213-3052 Ph: (503) 215-4860 |
| NPI Number | 1093963209 |
|---|---|
| Provider Enumeration Date | 08/29/2008 |
| Last Update Date | 09/23/2020 |
| Certification Date | 09/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093963209 | NPI | - | NPPES |
| 500611962 | Medicaid | OR | |
| 500601335 | Medicaid | OR |
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