| Providence Health & Services - Oregon | |
|
205 N Phoenix Rd Suite A Phoenix OR 97535-9104 | |
| (541) 732-5760 | |
| (541) 732-3406 |
| Full Name | Providence Health & Services - Oregon |
|---|---|
| Speciality | Clinic/center |
| Location | 205 N Phoenix Rd, Phoenix, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services - Oregon Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Health & Services - Oregon 205 N Phoenix Rd Suite A Phoenix OR 97535-9104 Ph: (541) 732-5760 |
| NPI Number | 1992882500 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 02/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992882500 | NPI | - | NPPES |
| 278307 | Medicaid | OR | |
| CG6801 | Other | OR | RAIL ROAD MEDIARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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