| Providence Medical Group | |
|
5211 Ne Glisan St Bldg C Portland OR 97213-3052 | |
| (503) 215-6628 | |
| (503) 215-6240 |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 5211 Ne Glisan St Bldg C, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 31001 - 4180 Pasadena CA 91110-4180 Ph: (503) 215-6628 | Providence Medical Group 5211 Ne Glisan St Bldg C Portland OR 97213-3052 Ph: (503) 215-6628 |
| NPI Number | 1003319724 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 06/20/2025 |
| Certification Date | 06/20/2025 |
| Medicare PECOS PAC ID | 0648183608 |
|---|---|
| Medicare Enrollment ID | O20180621000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003319724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 261Q00000X | Clinic/center | () | Primary |
Woodstock Family Medicine LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5536 Se Woodstock Blvd, Portland, OR 97206 Phone: 503-236-1830 Fax: 503-236-1908 |
Internal Medicine Consultants, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9585 Sw Washington Square Rd, Portland, OR 97223 Phone: 503-320-2121 Fax: 503-641-4158 |
The Wellness Center Pdx Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1359 Ne 35th Avenue, Portland, OR 97232 Phone: 503-389-5545 |
Interstate Medical Office West Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3325 N Interstate Ave, Portland, OR 97227 Phone: 800-813-2000 Fax: 503-286-6879 |
Jenna Halbert, ND LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Ne Russell St Ste 207, Portland, OR 97212 Phone: 503-482-8301 |
Jen Conjerti Acupuncture Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4445 Ne Fremont St, Portland, OR 97213 Phone: 503-984-4748 |