| Oak Grove Family Medical Clinic P C | |
|
2250 Se Oak Grove Blvd #b Milwaukie OR 97267-2670 | |
| (503) 654-6567 | |
| (503) 653-2582 |
| Full Name | Oak Grove Family Medical Clinic P C |
|---|---|
| Speciality | Family Medicine |
| Location | 2250 Se Oak Grove Blvd #b, Milwaukie, Oregon |
| Authorized Official Name and Position | Diana L Mikkelsen (OFFICE MANAGER) |
| Authorized Official Contact | 5036531860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Grove Family Medical Clinic P C 2250 Se Oak Grove Blvd Suite B Milwaukie OR 97267-2670 Ph: (503) 654-6567 | Oak Grove Family Medical Clinic P C 2250 Se Oak Grove Blvd #b Milwaukie OR 97267-2670 Ph: (503) 654-6567 |
| NPI Number | 1346218369 |
|---|---|
| Provider Enumeration Date | 03/08/2006 |
| Last Update Date | 06/01/2015 |
| Medicare PECOS PAC ID | 8729067442 |
|---|---|
| Medicare Enrollment ID | O20040722000300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346218369 | NPI | - | NPPES |
| A001 | Other | OR | CHAMPUS |
| CF9670 | Other | OR | RAILROAD MEDICARE |
| 067039000 | Other | OR | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Roberta W Ruggeri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396735254 PECOS PAC ID: 7911071899 Enrollment ID: I20110105000706 |
| Provider Name | Laura D Works |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730111485 PECOS PAC ID: 5193728657 Enrollment ID: I20150116001209 |
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