| Wellspring | |
|
2034 Se 6th Ave Portland OR 97214-4510 | |
| (503) 238-6801 | |
| (503) 238-6810 |
| Full Name | Wellspring |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2034 Se 6th Ave, Portland, Oregon |
| Authorized Official Name and Position | Debra Humphrey-keever (CFO) |
| Authorized Official Contact | 5039637786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Wellspring 2034 Se 6th Ave Portland OR 97214-4510 Ph: (503) 238-6801 |
| NPI Number | 1912046202 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912046202 | NPI | - | NPPES |
| 223347 | Medicaid | OR | |
| 226398 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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