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18650 Nw Cornell Rd Suite 212 Hillsboro OR 97124-9208 | |
(503) 216-9715 | |
Not Available |
Full Name | |
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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 |
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Po Box 3158 Portland OR 97208-3158 Ph: () - | 18650 Nw Cornell Rd Suite 212 Hillsboro OR 97124-9208 Ph: (503) 216-9715 |
NPI Number | 1932403029 |
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Provider Enumeration Date | 01/04/2011 |
Last Update Date | 11/20/2014 |
Identifier | Type | State | Issuer |
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1932403029 | NPI | - | NPPES |
500630158 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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