| Telecare Act-oregon | |
|
4101 Ne Division St Suite 100 Gresham OR 97030-4617 | |
| (503) 666-3808 | |
| (503) 666-6835 |
| Full Name | Telecare Act-oregon |
|---|---|
| Speciality | Clinic/Center |
| Location | 4101 Ne Division St, Gresham, Oregon |
| Authorized Official Name and Position | Lorena Lopez (PROVIDER RELATIONS SUPERVISOR) |
| Authorized Official Contact | 5102927024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Telecare Act-oregon 1080 Marina Village Pkwy Ste 100 Alameda CA 94501-1078 Ph: (503) 666-6575 | Telecare Act-oregon 4101 Ne Division St Suite 100 Gresham OR 97030-4617 Ph: (503) 666-3808 |
| NPI Number | 1386767176 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 09/08/2026 |
| Certification Date | 09/08/2026 |
| Medicare PECOS PAC ID | 1557460524 |
|---|---|
| Medicare Enrollment ID | O20070618000058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386767176 | NPI | - | NPPES |
| 274147 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Primary |
| Provider Name | Ben C Jew |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275636680 PECOS PAC ID: 4880692383 Enrollment ID: I20061116000472 |
| Provider Name | Wil C Berry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174840615 PECOS PAC ID: 2769631928 Enrollment ID: I20140728002310 |
| Provider Name | Lyle Lester Jobe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912963299 PECOS PAC ID: 3971492182 Enrollment ID: I20150708001640 |
| Provider Name | Michele T Sharp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629494018 PECOS PAC ID: 7810111838 Enrollment ID: I20160610000122 |
| Provider Name | Anne E Linton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003522319 PECOS PAC ID: 5395119069 Enrollment ID: I20230320002003 |
| Provider Name | Jensine Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427868546 PECOS PAC ID: 3476082264 Enrollment ID: I20250123001331 |
| Provider Name | Laurel Beth Sheppard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407802341 PECOS PAC ID: 7810956059 Enrollment ID: I20251013003718 |
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