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2801 N Gantenbein Ave Portland OR 97227 | |
(503) 413-2200 | |
(503) 413-2756 |
Full Name | |
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Speciality | Clinic/center |
Location | 2801 N Gantenbein Ave, Portland, Oregon |
Authorized Official Name and Position | Sarah Jensen (VP FINANCE) |
Authorized Official Contact | 5034155145 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 4399 Portland OR 97208-4399 Ph: (503) 413-3900 | 2801 N Gantenbein Ave Portland OR 97227 Ph: (503) 413-2200 |
NPI Number | 1073053757 |
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Provider Enumeration Date | 03/01/2017 |
Last Update Date | 02/06/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073053757 | NPI | - | NPPES |
500728535 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
282N00000X | General Acute Care Hospital | 14-0056 (Oregon) | Secondary |
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