| Char Glenn Md Llc | |
|
2525 Nw Lovejoy St Ste 405 Portland OR 97210-2865 | |
| (503) 274-9818 | |
| (503) 248-0049 |
| Full Name | Char Glenn Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2525 Nw Lovejoy St Ste 405, Portland, Oregon |
| Authorized Official Name and Position | Christopher Phillips (BILLING MANAGER) |
| Authorized Official Contact | 3606673047 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Char Glenn Md Llc Po Box 821350 Vancouver WA 98682-0030 Ph: (360) 687-5221 | Char Glenn Md Llc 2525 Nw Lovejoy St Ste 405 Portland OR 97210-2865 Ph: (503) 274-9818 |
| NPI Number | 1205893609 |
|---|---|
| Provider Enumeration Date | 04/28/2006 |
| Last Update Date | 11/09/2016 |
| Medicare PECOS PAC ID | 3678853041 |
|---|---|
| Medicare Enrollment ID | O20161201001631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205893609 | NPI | - | NPPES |
| 0599990000 | Other | OR | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Char Glenn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538201645 PECOS PAC ID: 6709069214 Enrollment ID: I20120127000746 |
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