| Providence Medical Group Wilsonville | |
|
29345 Sw Town Center Loop E Suite 110 Wilsonville OR 97070-8486 | |
| (503) 582-2100 | |
| Not Available |
| Full Name | Providence Medical Group Wilsonville |
|---|---|
| Speciality | Clinic/center |
| Location | 29345 Sw Town Center Loop E, Wilsonville, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB S) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Wilsonville Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Medical Group Wilsonville 29345 Sw Town Center Loop E Suite 110 Wilsonville OR 97070-8486 Ph: (503) 582-2100 |
| NPI Number | 1245489087 |
|---|---|
| Provider Enumeration Date | 09/17/2008 |
| Last Update Date | 04/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245489087 | NPI | - | NPPES |
| 500605247 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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