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171 N Larch St Ste 16 Cannon Beach OR 97110-3103 | |
(503) 717-7400 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 171 N Larch St Ste 16, Cannon Beach, Oregon |
Authorized Official Name and Position | Donald Wayne Anderson (ASST CORP SECRETARY FOR ENROLLMENTS) |
Authorized Official Contact | 4255255392 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 3397 Portland OR 97208-3397 Ph: (503) 893-7120 | 171 N Larch St Ste 16 Cannon Beach OR 97110-3103 Ph: (503) 717-7400 |
NPI Number | 1841756764 |
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Provider Enumeration Date | 02/15/2019 |
Last Update Date | 02/06/2020 |
Medicare PECOS PAC ID | 1557260106 |
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Medicare Enrollment ID | O20190607002251 |
Identifier | Type | State | Issuer |
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1841756764 | NPI | - | NPPES |