| Std Pivot | |
|
209 Sw 4th Ave Portland OR 97204-1813 | |
| (503) 445-7699 | |
| (503) 988-3015 |
| Full Name | Std Pivot |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 209 Sw 4th Ave, Portland, Oregon |
| Authorized Official Name and Position | Wendy Lear (DEPARTMENT DIRECTOR) |
| Authorized Official Contact | 5039887511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Std Pivot 421 Sw Oak St Ste. 210 Portland OR 97204-1817 Ph: (503) 988-7468 | Std Pivot 209 Sw 4th Ave Portland OR 97204-1813 Ph: (503) 445-7699 |
| NPI Number | 1417357443 |
|---|---|
| Provider Enumeration Date | 08/27/2014 |
| Last Update Date | 09/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417357443 | NPI | - | NPPES |
| 22959 | Medicaid | OR | |
| 096511 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (Oregon) | Primary |
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