| Providence Medical Group Milwaukie | |
|
10330 Se 32nd Ave Suite 305 Milwaukie OR 97222-6596 | |
| (503) 513-1800 | |
| (503) 513-1850 |
| Full Name | Providence Medical Group Milwaukie |
|---|---|
| Speciality | Clinic/center |
| Location | 10330 Se 32nd Ave, Milwaukie, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/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 Milwaukie Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Milwaukie 10330 Se 32nd Ave Suite 305 Milwaukie OR 97222-6596 Ph: (503) 513-1800 |
| NPI Number | 1013086875 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013086875 | NPI | - | NPPES |
| 022826 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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