| Providence Health Express At Gateway | |
|
1321 Ne 99th Ave Suite 110a Portland OR 97220-9436 | |
| (855) 229-6460 | |
| Not Available |
| Full Name | Providence Health Express At Gateway |
|---|---|
| Speciality | Clinic/center |
| Location | 1321 Ne 99th Ave, Portland, Oregon |
| Authorized Official Name and Position | Keenan B Freeman (CFO) |
| Authorized Official Contact | 5038936524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Express At Gateway Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Health Express At Gateway 1321 Ne 99th Ave Suite 110a Portland OR 97220-9436 Ph: (855) 229-6460 |
| NPI Number | 1710307715 |
|---|---|
| Provider Enumeration Date | 04/17/2014 |
| Last Update Date | 04/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710307715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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