| Providence St Vincent Heart Clinics Cardiology Westside Im | |
|
9155 Sw Barnes Rd Suite 238 Portland OR 97225-6629 | |
| (503) 297-5581 | |
| Not Available |
| Full Name | Providence St Vincent Heart Clinics Cardiology Westside Im |
|---|---|
| Speciality | Clinic/center |
| Location | 9155 Sw Barnes Rd, Portland, 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 Westside Im Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence St Vincent Heart Clinics Cardiology Westside Im 9155 Sw Barnes Rd Suite 238 Portland OR 97225-6629 Ph: (503) 297-5581 |
| NPI Number | 1104138445 |
|---|---|
| Provider Enumeration Date | 07/01/2010 |
| Last Update Date | 11/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104138445 | NPI | - | NPPES |
| 500628321 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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