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51730 Dexter St Blue River OR 97413-9776 | |
(541) 822-3341 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 51730 Dexter St, Blue River, Oregon |
Authorized Official Name and Position | Ariana Lee (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 9713734165 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 546 Gresham OR 97030-0132 Ph: (503) 782-8242 | 51730 Dexter St Blue River OR 97413-9776 Ph: (541) 822-3341 |
NPI Number | 1417098773 |
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Provider Enumeration Date | 02/09/2007 |
Last Update Date | 01/29/2025 |
Medicare PECOS PAC ID | 3476786609 |
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Medicare Enrollment ID | O20200228000357 |
Identifier | Type | State | Issuer |
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1417098773 | NPI | - | NPPES |
203935 | Medicaid | OR |