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4838 Sw Scholls Ferry Rd Portland OR 97225-1629 | |
(360) 260-8225 | |
(360) 397-0189 |
Full Name | |
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Speciality | Family Medicine |
Location | 4838 Sw Scholls Ferry Rd, Portland, Oregon |
Authorized Official Name and Position | Janice L Spencer (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 3602608225 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8404 Ne 16th St Vancouver WA 98664-4078 Ph: (360) 260-8225 | 4838 Sw Scholls Ferry Rd Portland OR 97225-1629 Ph: (360) 260-8225 |
NPI Number | 1982774543 |
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Provider Enumeration Date | 11/09/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 8426944422 |
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Medicare Enrollment ID | O20040226000189 |
Identifier | Type | State | Issuer |
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1982774543 | NPI | - | NPPES |
287059 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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207QG0300X | Family Medicine - Geriatric Medicine | MD10273 (Oregon) | Primary |
Provider Name | Harry Scott Krulewitch |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598799553 PECOS PAC ID: 0143116152 Enrollment ID: I20110428000637 |
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