| Healthy Living Community | |
|
3605 Se 26th Ave Portland OR 97202-2953 | |
| (971) 231-4536 | |
| (503) 376-3790 |
| Full Name | Healthy Living Community |
|---|---|
| Speciality | Clinic/Center |
| Location | 3605 Se 26th Ave, Portland, Oregon |
| Authorized Official Name and Position | Matthew S Whitacre (MEDICAL DIRECTOR / MD) |
| Authorized Official Contact | 3606408833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Living Community 3605 Se 26th Ave Portland OR 97202-2953 Ph: (971) 231-4536 | Healthy Living Community 3605 Se 26th Ave Portland OR 97202-2953 Ph: (971) 231-4536 |
| NPI Number | 1700446085 |
|---|---|
| Provider Enumeration Date | 06/18/2019 |
| Last Update Date | 07/26/2023 |
| Medicare PECOS PAC ID | 6204277817 |
|---|---|
| Medicare Enrollment ID | O20240514002875 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700446085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Suzanne Lyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962419721 PECOS PAC ID: 3072955285 Enrollment ID: I20240520002169 |
| Provider Name | Matthew Scott Whitacre |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730356858 PECOS PAC ID: 8123215241 Enrollment ID: I20240611003258 |
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