| Cognitive Care Medical Group Llc | |
|
12901 Se 97th Ave Ste 105 Clackamas OR 97015-7902 | |
| (503) 912-4788 | |
| (503) 912-4787 |
| Full Name | Cognitive Care Medical Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12901 Se 97th Ave Ste 105, Clackamas, Oregon |
| Authorized Official Name and Position | Eric George Wight (MANAGER) |
| Authorized Official Contact | 5039124790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Care Medical Group Llc 12901 Se 97th Ave Ste 105 Clackamas OR 97015-7902 Ph: (503) 912-4788 | Cognitive Care Medical Group Llc 12901 Se 97th Ave Ste 105 Clackamas OR 97015-7902 Ph: (503) 912-4788 |
| NPI Number | 1770023186 |
|---|---|
| Provider Enumeration Date | 03/03/2017 |
| Last Update Date | 09/12/2018 |
| Medicare PECOS PAC ID | 6103101498 |
|---|---|
| Medicare Enrollment ID | O20170329001297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770023186 | NPI | - | NPPES |
| 500723541 | Medicaid | OR |
| Provider Name | Heather L Knott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194900084 PECOS PAC ID: 6204029994 Enrollment ID: I20121210000048 |
| Provider Name | Kimberly A Sabin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669676193 PECOS PAC ID: 8628313681 Enrollment ID: I20181219000784 |
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