| Providence Medical Group Sunnyside | |
|
9290 Se Sunnybrook Blvd Suite 120 Clackamas OR 97015 | |
| (503) 215-2110 | |
| (503) 215-2115 |
| Full Name | Providence Medical Group Sunnyside |
|---|---|
| Speciality | Clinic/center |
| Location | 9290 Se Sunnybrook Blvd, Clackamas, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST CORP SECRETARY FOR ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Sunnyside Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Sunnyside 9290 Se Sunnybrook Blvd Suite 120 Clackamas OR 97015 Ph: (503) 215-2110 |
| NPI Number | 1245330380 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 07/09/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245330380 | NPI | - | NPPES |
| 043997 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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