| Providence Clinical Genetics | |
|
9427 Sw Barnes Rd Suite 598 Portland OR 97225-6652 | |
| (503) 215-8690 | |
| Not Available |
| Full Name | Providence Clinical Genetics |
|---|---|
| Speciality | Clinic/center |
| Location | 9427 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Mitchell S Neyhart (CFO) |
| Authorized Official Contact | 5035749840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Clinical Genetics Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Clinical Genetics 9427 Sw Barnes Rd Suite 598 Portland OR 97225-6652 Ph: (503) 215-8690 |
| NPI Number | 1518295849 |
|---|---|
| Provider Enumeration Date | 11/24/2009 |
| Last Update Date | 11/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518295849 | NPI | - | NPPES |
| 500615541 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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