| Pmg/47th Avenue | |
|
545 Ne 47th Ave Suite 106 Portland OR 97213-2238 | |
| (503) 215-9700 | |
| (503) 215-9701 |
| Full Name | Pmg/47th Avenue |
|---|---|
| Speciality | Clinic/center |
| Location | 545 Ne 47th Ave, Portland, Oregon |
| Authorized Official Name and Position | Mitchell Neyhart (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5035749840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmg/47th Avenue Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Pmg/47th Avenue 545 Ne 47th Ave Suite 106 Portland OR 97213-2238 Ph: (503) 215-9700 |
| NPI Number | 1932204039 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 04/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932204039 | NPI | - | NPPES |
| 134383 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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