| At Home Primary Care | |
|
511 Main St Suite 112 Oregon City OR 97045-1830 | |
| (503) 344-6717 | |
| (503) 345-9867 |
| Full Name | At Home Primary Care |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 511 Main St, Oregon City, Oregon |
| Authorized Official Name and Position | Monica Ferguson (CEO) |
| Authorized Official Contact | 5033587908 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| At Home Primary Care Po Box 945 Lake Oswego OR 97034-0103 Ph: (503) 344-6717 | At Home Primary Care 511 Main St Suite 112 Oregon City OR 97045-1830 Ph: (503) 344-6717 |
| NPI Number | 1336596113 |
|---|---|
| Provider Enumeration Date | 05/20/2016 |
| Last Update Date | 05/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336596113 | NPI | - | NPPES |
| 243056 | Medicaid | OR | |
| 200650008NP | Other | OR | NP LICENSE |
| R178969 | Other | OR | MEDICARE ID INDIV |
| 1932154366 | Other | OR | NPI INDIV |
| 500678021 | Medicaid | OR | |
| 1093053431 | Other | OR | NPI GROUP HMS |
| R178970 | Other | OR | MEDICARE ID GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 200650008NP (Oregon) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | 200650008NP (Oregon) | Secondary |
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