| Rose City Urgent Care And Family Practice | |
|
135 Ne 102nd Ave Portland OR 97220-4167 | |
| (503) 894-9005 | |
| (503) 719-4178 |
| Full Name | Rose City Urgent Care And Family Practice |
|---|---|
| Speciality | Clinic/center |
| Location | 135 Ne 102nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Maria Lynn Sullivan (BUSINESS DIRECTOR) |
| Authorized Official Contact | 5038949005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rose City Urgent Care And Family Practice 135 Ne 102nd Ave Portland OR 97220-4167 Ph: (503) 894-9005 | Rose City Urgent Care And Family Practice 135 Ne 102nd Ave Portland OR 97220-4167 Ph: (503) 894-9005 |
| NPI Number | 1417217894 |
|---|---|
| Provider Enumeration Date | 05/20/2012 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417217894 | NPI | - | NPPES |
| 500646730 | Medicaid | OR | |
| R167408 | Other | OR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 85696897 (Oregon) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | 85696897 (Oregon) | Secondary |
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