| Providence Pediatric Specialties 2 | |
|
501 N Graham St Suite 550 Portland OR 97227-2010 | |
| (503) 216-8654 | |
| (503) 216-8658 |
| Full Name | Providence Pediatric Specialties 2 |
|---|---|
| Speciality | Clinic/center |
| Location | 501 N Graham St, Portland, Oregon |
| Authorized Official Name and Position | Mitchell Neyhart (CFO) |
| Authorized Official Contact | 5035749840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Pediatric Specialties 2 Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Pediatric Specialties 2 501 N Graham St Suite 550 Portland OR 97227-2010 Ph: (503) 216-8654 |
| NPI Number | 1356433510 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 10/07/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356433510 | NPI | - | NPPES |
| 022859 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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