| Coffee Creek Correctional Facility | |
|
24499 Sw Grahams Ferry Rd Wilsonville OR 97070-7523 | |
| (503) 762-3431 | |
| (503) 762-8012 |
| Full Name | Coffee Creek Correctional Facility |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 24499 Sw Grahams Ferry Rd, Wilsonville, Oregon |
| Authorized Official Name and Position | Heather J Mcalpine (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5032380769 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coffee Creek Correctional Facility Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Coffee Creek Correctional Facility 24499 Sw Grahams Ferry Rd Wilsonville OR 97070-7523 Ph: (503) 762-3431 |
| NPI Number | 1992844195 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 07/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992844195 | NPI | - | NPPES |
| 226398 | Medicaid | OR | |
| 223347 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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