| Blackburn Center | |
|
12121 E Burnside St Portland OR 97216-3737 | |
| (971) 361-7700 | |
| Not Available |
| Full Name | Blackburn Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12121 E Burnside St, Portland, Oregon |
| Authorized Official Name and Position | Andrew Mendenhall (PRESIDENT & CEO) |
| Authorized Official Contact | 5032941681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackburn Center 232 Nw 6th Avenue Attn: Credentialing Portland OR 97209 Ph: (503) 501-5641 | Blackburn Center 12121 E Burnside St Portland OR 97216-3737 Ph: (971) 361-7700 |
| NPI Number | 1932674801 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 07/15/2024 |
| Medicare PECOS PAC ID | 6103803259 |
|---|---|
| Medicare Enrollment ID | O20190116001366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932674801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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