| Internal Medicine Of Oregon, Llc | |
|
5050 Ne Hoyt St Suite 203 Portland OR 97213-2991 | |
| (503) 230-9224 | |
| (503) 230-9201 |
| Full Name | Internal Medicine Of Oregon, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5050 Ne Hoyt St, Portland, Oregon |
| Authorized Official Name and Position | Porfirio Pena (OWNER) |
| Authorized Official Contact | 5032309224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Of Oregon, Llc 5050 Ne Hoyt St Suite 203 Portland OR 97213-2991 Ph: (503) 230-9224 | Internal Medicine Of Oregon, Llc 5050 Ne Hoyt St Suite 203 Portland OR 97213-2991 Ph: (503) 230-9224 |
| NPI Number | 1538355417 |
|---|---|
| Provider Enumeration Date | 09/24/2007 |
| Last Update Date | 11/26/2007 |
| Medicare PECOS PAC ID | 5799871786 |
|---|---|
| Medicare Enrollment ID | O20071023000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538355417 | NPI | - | NPPES |
| 000810 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD15289 (Oregon) | Primary |
| Provider Name | Porfirio Pena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255496709 PECOS PAC ID: 6507841525 Enrollment ID: I20071023000044 |
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