| Gresham | |
|
400 Ne 7th St Gresham OR 97030-5604 | |
| (503) 238-0769 | |
| (503) 889-2599 |
| Full Name | Gresham |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 400 Ne 7th St, Gresham, 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 |
|---|---|
| Gresham Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Gresham 400 Ne 7th St Gresham OR 97030-5604 Ph: (503) 238-0769 |
| NPI Number | 1235171323 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235171323 | NPI | - | NPPES |
| 223347 | Medicaid | OR | |
| 226398 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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