| Providence St Vincent Heart Clinic Cardiology Tanasbourne | |
|
18650 Nw Cornell Rd Suite 212 Hillsboro OR 97124-9208 | |
| (503) 216-9715 | |
| Not Available |
| Full Name | Providence St Vincent Heart Clinic Cardiology Tanasbourne |
|---|---|
| Speciality | Clinic/center |
| Location | 18650 Nw Cornell Rd, Hillsboro, Oregon |
| Authorized Official Name and Position | Keenan B Freeman (CFO) |
| Authorized Official Contact | 5038936524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence St Vincent Heart Clinic Cardiology Tanasbourne Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence St Vincent Heart Clinic Cardiology Tanasbourne 18650 Nw Cornell Rd Suite 212 Hillsboro OR 97124-9208 Ph: (503) 216-9715 |
| NPI Number | 1932403029 |
|---|---|
| Provider Enumeration Date | 01/04/2011 |
| Last Update Date | 11/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932403029 | NPI | - | NPPES |
| 500630158 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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