| Providence Medical Group | |
|
5330 Ne Glisan St Suite 100 Portland OR 97213-3069 | |
| (503) 215-9706 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 5330 Ne Glisan St, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASST SECRETARY ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group 5330 Ne Glisan St Suite 100 Portland OR 97213-3069 Ph: (503) 215-9706 |
| NPI Number | 1841466141 |
|---|---|
| Provider Enumeration Date | 05/06/2008 |
| Last Update Date | 06/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841466141 | NPI | - | NPPES |
| 500400318 | Medicaid | OR |
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The Wellness Center Pdx Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1359 Ne 35th Avenue, Portland, OR 97232 Phone: 503-389-5545 | |
Providence Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5211 Ne Glisan St Bldg C, Portland, OR 97213 Phone: 503-215-6628 Fax: 503-215-6240 | |
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