| Multnomah County Health Dept, Southeast | |
|
3653 Se 34th Ave Portland OR 97202-3034 | |
| (503) 988-7462 | |
| (503) 988-3015 |
| Full Name | Multnomah County Health Dept, Southeast |
|---|---|
| Speciality | Clinic/Center |
| Location | 3653 Se 34th Ave, Portland, Oregon |
| Authorized Official Name and Position | Derrick Moten (INTERIM BUSINESS SERVICES DIRECTOR) |
| Authorized Official Contact | 5039882966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Multnomah County Health Dept, Southeast 619 Nw 6th Ave Ste 500 Portland OR 97209-3964 Ph: (503) 988-7468 | Multnomah County Health Dept, Southeast 3653 Se 34th Ave Portland OR 97202-3034 Ph: (503) 988-7462 |
| NPI Number | 1720126816 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 05/18/2024 |
| Medicare PECOS PAC ID | 6608771787 |
|---|---|
| Medicare Enrollment ID | O20090414000219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720126816 | NPI | - | NPPES |
| 096511 | Medicaid | OR | |
| 022959 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oregon) | Secondary |
| 261QP0905X | Clinic/center - Public Health, State Or Local | (Oregon) | Primary |
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