| Providence Medical Group Gateway Family & Community Medicine | |
|
1321 Ne 99th Ave Suite 200 Portland OR 97220-9439 | |
| (503) 215-4250 | |
| (503) 215-4255 |
| Full Name | Providence Medical Group Gateway Family & Community Medicine |
|---|---|
| Speciality | Clinic/center |
| Location | 1321 Ne 99th Ave, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Gateway Family & Community Medicine Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6446 | Providence Medical Group Gateway Family & Community Medicine 1321 Ne 99th Ave Suite 200 Portland OR 97220-9439 Ph: (503) 215-4250 |
| NPI Number | 1124129903 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 10/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124129903 | NPI | - | NPPES |
| 022844 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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