| Ups Gabriel Park (oha Pcpch) | |
|
4411 Sw Vermont St Portland OR 97219-1020 | |
| (503) 494-9992 | |
| Not Available |
| Full Name | Ups Gabriel Park (oha Pcpch) |
|---|---|
| Speciality | General Practice |
| Location | 4411 Sw Vermont St, Portland, Oregon |
| Authorized Official Name and Position | Kelly Smith (VICE PRESIDENT, ERC) |
| Authorized Official Contact | 5034948417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ups Gabriel Park (oha Pcpch) 1400 Sw 5th Ave Ste 500 Portland OR 97201-5537 Ph: (503) 494-8417 | Ups Gabriel Park (oha Pcpch) 4411 Sw Vermont St Portland OR 97219-1020 Ph: (503) 494-9992 |
| NPI Number | 1033466206 |
|---|---|
| Provider Enumeration Date | 08/07/2012 |
| Last Update Date | 08/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033466206 | NPI | - | NPPES |
| 500646498 (MCD) | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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