| Professional Medical Services Llc | |
|
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011 | |
| (503) 494-8311 | |
| Not Available |
| Full Name | Professional Medical Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3181 Sw Sam Jackson Park Rd, Portland, Oregon |
| Authorized Official Name and Position | Matthew L. Navigato (DIRECTOR, ENTERPRISE REVENUE CYCLE) |
| Authorized Official Contact | 5034946619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Medical Services Llc 2055 Nw Savier St Suite 201 Portland OR 97209-1770 Ph: (503) 494-8417 | Professional Medical Services Llc 3181 Sw Sam Jackson Park Rd Portland OR 97239-3011 Ph: (503) 494-8311 |
| NPI Number | 1770687253 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 08/26/2016 |
| Medicare PECOS PAC ID | 3870489388 |
|---|---|
| Medicare Enrollment ID | O20161027001565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770687253 | NPI | - | NPPES |
| 227631 | Medicaid | OR | |
| 7119944 | Medicaid | WA | |
| DC4123 | Other | OR | RAILROAD MEDICARE |
| 227639 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | (* (Not Available)) | Secondary |
| Provider Name | Onyekachi Ogbonna |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1992090112 PECOS PAC ID: 3375853435 Enrollment ID: I20200724000489 |
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