| Multnomah County | |
|
12710 Se Division St Portland OR 97236-3134 | |
| (503) 988-3663 | |
| (503) 988-3015 |
| Full Name | Multnomah County |
|---|---|
| Speciality | Clinic/Center |
| Location | 12710 Se Division St, Portland, Oregon |
| Authorized Official Name and Position | Wendy Lear (BUSINESS SERVICES MANAGER) |
| Authorized Official Contact | 5039887462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Multnomah County 619 Nw 6th Ave Ste 500 Portland OR 97209-3964 Ph: (503) 988-7468 | Multnomah County 12710 Se Division St Portland OR 97236-3134 Ph: (503) 988-3663 |
| NPI Number | 1245378322 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 02/03/2020 |
| Medicare PECOS PAC ID | 6608771787 |
|---|---|
| Medicare Enrollment ID | O20090414000253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245378322 | NPI | - | NPPES |
| 096511 | Medicaid | OR | |
| 022959 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (Oregon) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oregon) | Primary |
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