| Family Medical Group Northeast, P.c. | |
|
2647 Ne 33rd Ave Portland OR 97212-3647 | |
| (503) 288-0083 | |
| (503) 288-7843 |
| Full Name | Family Medical Group Northeast, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 2647 Ne 33rd Ave, Portland, Oregon |
| Authorized Official Name and Position | Keirene Adams (ADMINISTRATOR) |
| Authorized Official Contact | 5032880083 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Group Northeast, P.c. 2647 Ne 33rd Ave Portland OR 97212-3647 Ph: (503) 288-0083 | Family Medical Group Northeast, P.c. 2647 Ne 33rd Ave Portland OR 97212-3647 Ph: (503) 288-0083 |
| NPI Number | 1831385673 |
|---|---|
| Provider Enumeration Date | 09/14/2007 |
| Last Update Date | 09/14/2007 |
| Medicare PECOS PAC ID | 2365430709 |
|---|---|
| Medicare Enrollment ID | O20040504000835 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831385673 | NPI | - | NPPES |
| R000WCHMD | Other | OR | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lonnie L Smucker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548293087 PECOS PAC ID: 2062326614 Enrollment ID: I20031118000170 |
| Provider Name | Susan M Vockert-burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245419399 PECOS PAC ID: 4486743218 Enrollment ID: I20071203000099 |
| Provider Name | Anne N Skinner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528124120 PECOS PAC ID: 1557466729 Enrollment ID: I20101110000641 |
| Provider Name | Emi A Koda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619256021 PECOS PAC ID: 5799918421 Enrollment ID: I20140829000576 |
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