Providence Health Express Bp | |
18040 Sw Lower Boones Ferry Rd Suite 100 Tigard OR 97224-7259 | |
(855) 229-6460 | |
(503) 216-0710 |
Full Name | Providence Health Express Bp |
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Speciality | Nurse Practitioner |
Location | 18040 Sw Lower Boones Ferry Rd, Tigard, 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 |
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Providence Health Express Bp Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Health Express Bp 18040 Sw Lower Boones Ferry Rd Suite 100 Tigard OR 97224-7259 Ph: (855) 229-6460 |
NPI Number | 1790113405 |
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Provider Enumeration Date | 10/16/2013 |
Last Update Date | 10/16/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790113405 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
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