| Providence Heart Clinic Milwaukie | |
|
10330 Se 32nd Ave Suite 210 Milwaukie OR 97222-6594 | |
| (503) 962-1000 | |
| Not Available |
| Full Name | Providence Heart Clinic Milwaukie |
|---|---|
| Speciality | Clinic/center |
| Location | 10330 Se 32nd Ave, Milwaukie, 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 Heart Clinic Milwaukie Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Heart Clinic Milwaukie 10330 Se 32nd Ave Suite 210 Milwaukie OR 97222-6594 Ph: (503) 962-1000 |
| NPI Number | 1982997128 |
|---|---|
| Provider Enumeration Date | 05/20/2011 |
| Last Update Date | 09/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982997128 | NPI | - | NPPES |
| 500638985 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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