| Sunset Family Practice Group Pc | |
|
12400 Nw Cornell Rd Portland OR 97229-5616 | |
| (503) 626-0939 | |
| (503) 626-6161 |
| Full Name | Sunset Family Practice Group Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 12400 Nw Cornell Rd, Portland, Oregon |
| Authorized Official Name and Position | Vic Krisciunas (LEAD PHYSICIAN) |
| Authorized Official Contact | 5036260939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunset Family Practice Group Pc 12400 Nw Cornell Rd P.o. Box 2767 Portland OR 97229-5616 Ph: (503) 626-0939 | Sunset Family Practice Group Pc 12400 Nw Cornell Rd Portland OR 97229-5616 Ph: (503) 626-0939 |
| NPI Number | 1568408680 |
|---|---|
| Provider Enumeration Date | 06/20/2006 |
| Last Update Date | 07/27/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568408680 | NPI | - | NPPES |
| 141978 | Other | OR | PTAN |
| 1508809781 | Other | OR | NPI |
| 38D0621672 | Other | CLIA | |
| 11896 | Other | OR | PTAN |
| 1437190741 | Other | OR | NPI |
| DOWCQKWB | Other | OR | PTAN |
| 1912014317 | Other | OR | NPI |
| 1841236924 | Other | OR | NPI |
| 1891736104 | Other | OR | NPI |
| DOWCQKWC | Other | OR | PTAN |
| R00WCQKWD | Other | OR | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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