| Goldmark Wound Specialty Group Mpo, Llc | |
|
7150 Sw Hampton St Ste 101 Tigard OR 97223-8365 | |
| (971) 236-4445 | |
| (971) 236-4445 |
| Full Name | Goldmark Wound Specialty Group Mpo, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7150 Sw Hampton St Ste 101, Tigard, Oregon |
| Authorized Official Name and Position | Heidi Hagman (OWNER/ MEDICAL DIRECTOR) |
| Authorized Official Contact | 9719103888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goldmark Wound Specialty Group Mpo, Llc 7150 Sw Hampton St Ste 101 Tigard OR 97223-8365 Ph: (971) 236-4445 | Goldmark Wound Specialty Group Mpo, Llc 7150 Sw Hampton St Ste 101 Tigard OR 97223-8365 Ph: (971) 236-4445 |
| NPI Number | 1568287688 |
|---|---|
| Provider Enumeration Date | 11/22/2024 |
| Last Update Date | 11/22/2024 |
| Medicare PECOS PAC ID | 0840727913 |
|---|---|
| Medicare Enrollment ID | O20241231002636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568287688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Heidi M Hagman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962489575 PECOS PAC ID: 8224037353 Enrollment ID: I20061218000552 |
| Provider Name | Kathleen Patricia Kerwan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902835838 PECOS PAC ID: 7416034137 Enrollment ID: I20090921000292 |
| Provider Name | Adeline E Hij |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225852148 PECOS PAC ID: 9739616814 Enrollment ID: I20241231003323 |
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