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909 Sw 18th Ave Portland OR 97205-1705 | |
(503) 962-1946 | |
(503) 962-1925 |
Full Name | |
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Speciality | Clinic/center |
Location | 909 Sw 18th Ave, Portland, Oregon |
Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB) |
Authorized Official Contact | 4252763215 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | 909 Sw 18th Ave Portland OR 97205-1705 Ph: (503) 962-1946 |
NPI Number | 1235479643 |
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Provider Enumeration Date | 02/21/2013 |
Last Update Date | 08/20/2021 |
Identifier | Type | State | Issuer |
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1235479643 | NPI | - | NPPES |
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