| Mth Clinic Pc | |
|
24988 Se Stark St Ste 300 Gresham OR 97030-8322 | |
| (503) 674-5818 | |
| (503) 674-6709 |
| Full Name | Mth Clinic Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 24988 Se Stark St, Gresham, Oregon |
| Authorized Official Name and Position | Fayyaz Mahmood (CEO) |
| Authorized Official Contact | 5036745818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mth Clinic Pc 24988 Se Stark St Ste 300 Gresham OR 97030-8322 Ph: (503) 674-5818 | Mth Clinic Pc 24988 Se Stark St Ste 300 Gresham OR 97030-8322 Ph: (503) 674-5818 |
| NPI Number | 1558354522 |
|---|---|
| Provider Enumeration Date | 08/25/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3971576455 |
|---|---|
| Medicare Enrollment ID | O20040813000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558354522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Oregon) | Primary |
| Provider Name | Fayyaz Mahmood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790777050 PECOS PAC ID: 7416146790 Enrollment ID: I20110118001265 |
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