| Providence Peds Spec Mjp | |
|
9427 Sw Barnes Rd Suite 598 Portland OR 97225-6652 | |
| (503) 216-8654 | |
| (503) 216-8658 |
| Full Name | Providence Peds Spec Mjp |
|---|---|
| Speciality | Clinic/center |
| Location | 9427 Sw Barnes Rd, 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 Peds Spec Mjp Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Peds Spec Mjp 9427 Sw Barnes Rd Suite 598 Portland OR 97225-6652 Ph: (503) 216-8654 |
| NPI Number | 1033299458 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 11/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033299458 | NPI | - | NPPES |
| 022858 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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