| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 727 S Wahanna Rd, Seaside, Oregon |
| Authorized Official Name and Position | Donald Anderson (ASST CORP SEC FOR ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3397 Portland OR 97208-3397 Ph: (503) 215-4323 | 727 S Wahanna Rd Seaside OR 97138 Ph: (503) 717-7000 |
| NPI Number | 1649344458 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 06/06/2018 |
| Medicare PECOS PAC ID | 1557260106 |
|---|---|
| Medicare Enrollment ID | O20050815001030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649344458 | NPI | - | NPPES |
| 039607 | Other | OR | MEDICAID CLINIC - 1500 BILLING |
| C13774 | Other | OR | RAILROAD MEDICARE |
| 000138 | Medicaid | OR | |
| 015560000 | Other | OR | REGENCE BCBSO CLINIC # |
| 7042567 | Other | OR | WASHINGTON MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Masud K Ahmad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780620880 PECOS PAC ID: 2961302872 Enrollment ID: I20051205000133 |