| Providence Medical Group | |
|
9155 Sw Barnes Rd Suite 638 Portland OR 97225-6633 | |
| (503) 216-7000 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 9155 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT 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 9155 Sw Barnes Rd Suite 638 Portland OR 97225-6633 Ph: (503) 216-7000 |
| NPI Number | 1568541894 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 06/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568541894 | NPI | - | NPPES |
| 278517 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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