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1411 Sw Morrison St Portland OR 97205-1945 | |
(503) 352-2400 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 1411 Sw Morrison St, Portland, Oregon |
Authorized Official Name and Position | Mary Von (INTERIM DIRECTOR) |
Authorized Official Contact | 5033527272 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1411 Sw Morrison St Portland OR 97205-1945 Ph: (503) 352-2400 | 1411 Sw Morrison St Portland OR 97205-1945 Ph: (503) 352-2400 |
NPI Number | 1558776955 |
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Provider Enumeration Date | 06/24/2014 |
Last Update Date | 10/26/2021 |
Identifier | Type | State | Issuer |
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1558776955 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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