| Providence St Vincent Heart Clinics Cardiology Bridgeport | |
|
18040 Sw Lower Boones Ferry Rd Suite 204 Tigard OR 97224-7259 | |
| (503) 216-6060 | |
| (503) 216-6040 |
| Full Name | Providence St Vincent Heart Clinics Cardiology Bridgeport |
|---|---|
| Speciality | Clinic/center |
| Location | 18040 Sw Lower Boones Ferry Rd, Tigard, 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 Clinics Cardiology Bridgeport Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence St Vincent Heart Clinics Cardiology Bridgeport 18040 Sw Lower Boones Ferry Rd Suite 204 Tigard OR 97224-7259 Ph: (503) 216-6060 |
| NPI Number | 1588981963 |
|---|---|
| Provider Enumeration Date | 04/26/2010 |
| Last Update Date | 06/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588981963 | NPI | - | NPPES |
| 500622006 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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