| Willamette Valley Immunology Center Pc | |
|
169 Ne 102nd Ave Portland OR 97220-4169 | |
| (503) 262-7273 | |
| (503) 262-7274 |
| Full Name | Willamette Valley Immunology Center Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 169 Ne 102nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Thomas Jefferson Saddoris (PHYSICIAN OWNER) |
| Authorized Official Contact | 5032627273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willamette Valley Immunology Center Pc 169 Ne 102nd Ave Portland OR 97220-4169 Ph: (503) 262-7273 | Willamette Valley Immunology Center Pc 169 Ne 102nd Ave Portland OR 97220-4169 Ph: (503) 262-7273 |
| NPI Number | 1952622508 |
|---|---|
| Provider Enumeration Date | 06/17/2010 |
| Last Update Date | 06/17/2010 |
| Medicare PECOS PAC ID | 3779615174 |
|---|---|
| Medicare Enrollment ID | O20100721000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952622508 | NPI | - | NPPES |
| 18374 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD10197 (Oregon) | Primary |
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