| Providence Medical Group | |
|
9155 Sw Barnes Rd Ste 333 Portland OR 97225-6625 | |
| (503) 216-5102 | |
| (503) 216-2485 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 9155 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY ENROLLMENT) |
| 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 333 Portland OR 97225-6625 Ph: (503) 216-5102 |
| NPI Number | 1013192806 |
|---|---|
| Provider Enumeration Date | 12/31/2007 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013192806 | NPI | - | NPPES |
| 245786 | Medicaid | OR | |
| 500601075 | Medicaid | OR |
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