| Beaverton | |
|
14195 Sw Millikan Way Beaverton OR 97005-2307 | |
| (503) 238-0769 | |
| (503) 889-2599 |
| Full Name | Beaverton |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 14195 Sw Millikan Way, Beaverton, Oregon |
| Authorized Official Name and Position | Enrique Sama (VP, HUMAN RESOURCES) |
| Authorized Official Contact | 5039637791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaverton Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Beaverton 14195 Sw Millikan Way Beaverton OR 97005-2307 Ph: (503) 238-0769 |
| NPI Number | 1659327799 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659327799 | NPI | - | NPPES |
| 226398 | Medicaid | OR | |
| 223347 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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