| Providence Medical Group | |
|
16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 | |
| (503) 216-9600 | |
| (503) 216-9650 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 16770 Sw Edy Rd, Sherwood, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR 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: (503) 215-6494 | Providence Medical Group 16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 Ph: (503) 216-9600 |
| NPI Number | 1184729329 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 08/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184729329 | NPI | - | NPPES |
| 500400324 | Medicaid | OR | |
| 022851 | Medicaid | OR |
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