| Mtn. View Family Practice, Pc | |
|
24900 Se Stark St Suite 205 Gresham OR 97030-3355 | |
| (503) 665-1010 | |
| (503) 665-1023 |
| Full Name | Mtn. View Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 24900 Se Stark St, Gresham, Oregon |
| Authorized Official Name and Position | Paul V Podett (PRESIDENT) |
| Authorized Official Contact | 5036651010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mtn. View Family Practice, Pc 24900 Se Stark St Suite 205 Gresham OR 97030-3355 Ph: (503) 665-1010 | Mtn. View Family Practice, Pc 24900 Se Stark St Suite 205 Gresham OR 97030-3355 Ph: (503) 665-1010 |
| NPI Number | 1861520991 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 03/25/2014 |
| Medicare PECOS PAC ID | 6608841432 |
|---|---|
| Medicare Enrollment ID | O20040826000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861520991 | NPI | - | NPPES |
| MD18120 | Other | OR | MD LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD18120 (Oregon) | Primary |
| Provider Name | Paul V Podett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184783094 PECOS PAC ID: 7618880949 Enrollment ID: I20031111000847 |
| Provider Name | Craig Steven Haggett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447672134 PECOS PAC ID: 6608232855 Enrollment ID: I20230515001410 |
| Provider Name | Tenzin Tsering Lama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477216950 PECOS PAC ID: 7214463223 Enrollment ID: I20241212004031 |
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