| Portland Avenue Family Clinic | |
|
4314 E Portland Ave Suite7 Tacoma WA 98404-4696 | |
| (253) 476-9121 | |
| (253) 476-8942 |
| Full Name | Portland Avenue Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4314 E Portland Ave, Tacoma, Washington |
| Authorized Official Name and Position | Poly Leng (MANAGER) |
| Authorized Official Contact | 2534769121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Avenue Family Clinic 4314 E Portland Ave Suite7 Tacoma WA 98404-4696 Ph: (253) 476-9121 | Portland Avenue Family Clinic 4314 E Portland Ave Suite7 Tacoma WA 98404-4696 Ph: (253) 476-9121 |
| NPI Number | 1922139534 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 03/05/2013 |
| Medicare PECOS PAC ID | 4789574674 |
|---|---|
| Medicare Enrollment ID | O20040316000735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922139534 | NPI | - | NPPES |
| 7084163 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Washington) | Primary |
| Provider Name | Oscar M Ortega |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225192784 PECOS PAC ID: 2961438916 Enrollment ID: I20050712000451 |
| Provider Name | Benjamin O Dy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831253368 PECOS PAC ID: 8820267628 Enrollment ID: I20110812000135 |
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