| Providence Medical Group Sunset | |
|
417 Sw 117th Ave 2nd Floor Portland OR 97225-5924 | |
| (503) 216-9400 | |
| (503) 216-9499 |
| Full Name | Providence Medical Group Sunset |
|---|---|
| Speciality | Clinic/center |
| Location | 417 Sw 117th Ave, Portland, 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 Sunset Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Sunset 417 Sw 117th Ave 2nd Floor Portland OR 97225-5924 Ph: (503) 216-9400 |
| NPI Number | 1083714141 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 09/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083714141 | NPI | - | NPPES |
| 065003 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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