| Wellington Provider Group, Pc | |
|
10260 Sw Greenburg Rd Fl 4 Portland OR 97223-5500 | |
| (859) 439-0400 | |
| Not Available |
| Full Name | Wellington Provider Group, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 10260 Sw Greenburg Rd Fl 4, Portland, Oregon |
| Authorized Official Name and Position | Mariela Bravo (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 8313136799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group, Pc 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: () - | Wellington Provider Group, Pc 10260 Sw Greenburg Rd Fl 4 Portland OR 97223-5500 Ph: (859) 439-0400 |
| NPI Number | 1619689957 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 8123412459 |
|---|---|
| Medicare Enrollment ID | O20230206000365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619689957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark Goodman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609018860 PECOS PAC ID: 2668643008 Enrollment ID: I20130215000251 |
| Provider Name | Carl Seger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699957308 PECOS PAC ID: 1951455773 Enrollment ID: I20141121002179 |
| Provider Name | Michael Stone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043201262 PECOS PAC ID: 0143275016 Enrollment ID: I20160706001250 |
| Provider Name | Michael Mallin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730330788 PECOS PAC ID: 8224180989 Enrollment ID: I20170621000636 |
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