Providence Medical Group Sherwood | |
16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 | |
(503) 216-9600 | |
(503) 216-9650 |
Full Name | Providence Medical Group Sherwood |
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Speciality | Clinic/center |
Location | 16770 Sw Edy Rd, Sherwood, Oregon |
Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB S) |
Authorized Official Contact | 4255255392 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Providence Medical Group Sherwood Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Sherwood 16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 Ph: (503) 216-9600 |
NPI Number | 1184729329 |
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Provider Enumeration Date | 09/13/2006 |
Last Update Date | 04/16/2021 |
Certification Date | 04/16/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184729329 | NPI | - | NPPES |
500400324 | Medicaid | OR | |
022851 | Medicaid | OR |
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