| Providence Medical Group Sherwood Immediate Care | |
|
16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 | |
| (503) 216-9600 | |
| Not Available |
| Full Name | Providence Medical Group Sherwood Immediate Care |
|---|---|
| Speciality | Clinic/center |
| Location | 16770 Sw Edy Rd, Sherwood, 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 Sherwood Immediate Care Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group Sherwood Immediate Care 16770 Sw Edy Rd Suite 102 Sherwood OR 97140-9679 Ph: (503) 216-9600 |
| NPI Number | 1013143478 |
|---|---|
| Provider Enumeration Date | 05/29/2009 |
| Last Update Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013143478 | NPI | - | NPPES |
| 500611226 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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