| Providence Medical Group | |
|
16180 Se Sunnyside Road Suite 102 Happy Valley OR 97015-6302 | |
| (503) 582-4900 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Clinic/center |
| Location | 16180 Se Sunnyside Road, Happy Valley, Oregon |
| Authorized Official Name and Position | Donald W Anderson (EVP/ASST SEC ENROLL) |
| 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 16180 Se Sunnyside Road Suite 102 Happy Valley OR 97015-6302 Ph: (503) 582-4900 |
| NPI Number | 1508015348 |
|---|---|
| Provider Enumeration Date | 09/17/2008 |
| Last Update Date | 06/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508015348 | NPI | - | NPPES |
| 500612832 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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