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4540 Ne Glisan St Portland OR 97213-2333 | |
(503) 215-3738 | |
(503) 215-6942 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 4540 Ne Glisan St, Portland, Oregon |
Authorized Official Name and Position | Donald M Keister (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 5032153612 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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13007 Ne Glisan St Portland OR 97230-2545 Ph: (503) 215-6556 | 4540 Ne Glisan St Portland OR 97213-2333 Ph: (503) 215-3738 |
NPI Number | 1023098118 |
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Provider Enumeration Date | 01/17/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023098118 | NPI | - | NPPES |
005673 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Woodstock Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5536 Se Woodstock Blvd, Portland, OR 97206 Phone: 503-236-1830 Fax: 503-236-1908 | |
Internal Medicine Consultants, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9585 Sw Washington Square Rd, Portland, OR 97223 Phone: 503-320-2121 Fax: 503-641-4158 | |
Jenna Halbert, Nd Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Ne Russell St Ste 207, Portland, OR 97212 Phone: 503-482-8301 | |