| Western U Medical Group, Llc | |
|
5909 Se 92nd Ave Portland OR 97266-4642 | |
| (909) 469-8534 | |
| Not Available |
| Full Name | Western U Medical Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5909 Se 92nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Trena Rich (DIRECTOR OF CLINICAL COMPLIANCE) |
| Authorized Official Contact | 9097063871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western U Medical Group, Llc 795 E. Second Street Suite 5 Pomona CA 91766 Ph: (909) 469-8332 | Western U Medical Group, Llc 5909 Se 92nd Ave Portland OR 97266-4642 Ph: (909) 469-8534 |
| NPI Number | 1942791611 |
|---|---|
| Provider Enumeration Date | 05/29/2018 |
| Last Update Date | 11/30/2018 |
| Medicare PECOS PAC ID | 9739502212 |
|---|---|
| Medicare Enrollment ID | O20200701001577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942791611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Oregon) | Primary |
| Provider Name | Melanie J Smythe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043214471 PECOS PAC ID: 9931157831 Enrollment ID: I20050107000117 |
| Provider Name | Robin L Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437165453 PECOS PAC ID: 4082607981 Enrollment ID: I20060106000063 |
| Provider Name | John T Pham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912061623 PECOS PAC ID: 9739174103 Enrollment ID: I20090304000837 |
| Provider Name | Lawrence S Tremaine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447334032 PECOS PAC ID: 9133431760 Enrollment ID: I20170814002672 |
| Provider Name | Edward Y Lin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659783546 PECOS PAC ID: 0446525174 Enrollment ID: I20171006000029 |
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