Providence Medical Group Infectious Disease Consultants East | |
5050 Ne Hoyt St Suite 540 Portland OR 97213-2985 | |
(503) 215-6601 | |
(503) 215-6727 |
Full Name | Providence Medical Group Infectious Disease Consultants East |
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Speciality | Clinic/center |
Location | 5050 Ne Hoyt St, Portland, 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 |
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Providence Medical Group Infectious Disease Consultants East Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group Infectious Disease Consultants East 5050 Ne Hoyt St Suite 540 Portland OR 97213-2985 Ph: (503) 215-6601 |
NPI Number | 1205188893 |
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Provider Enumeration Date | 10/08/2012 |
Last Update Date | 09/23/2013 |
Identifier | Type | State | Issuer |
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1205188893 | NPI | - | NPPES |
500653865 | Medicaid | OR |
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