| Ohsu Family Medicine At Richmond Walk-in Clinic | |
|
4212 Se Division St Ste 150 Portland OR 97206-1681 | |
| (503) 418-1500 | |
| (503) 418-3939 |
| Full Name | Ohsu Family Medicine At Richmond Walk-in Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4212 Se Division St Ste 150, Portland, Oregon |
| Authorized Official Name and Position | Danny O. Jacobs (PRESIDENT) |
| Authorized Official Contact | 5034948252 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ohsu Family Medicine At Richmond Walk-in Clinic 4212 Se Division St Ste 150 Portland OR 97206-1681 Ph: (503) 418-1500 | Ohsu Family Medicine At Richmond Walk-in Clinic 4212 Se Division St Ste 150 Portland OR 97206-1681 Ph: (503) 418-1500 |
| NPI Number | 1487902706 |
|---|---|
| Provider Enumeration Date | 08/16/2012 |
| Last Update Date | 02/07/2022 |
| Medicare PECOS PAC ID | 1759328842 |
|---|---|
| Medicare Enrollment ID | O20130805000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487902706 | NPI | - | NPPES |
| 500682277 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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