| Providence Medical Group | |
|
9427 Sw Barnes Rd Suite 595 Portland OR 97225-6640 | |
| (503) 216-2346 | |
| Not Available |
| Full Name | Providence Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 9427 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (ASST SEC ENROLL) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Po Box 31001 - 4180 Pasadena CA 91110-4180 Ph: (503) 215-6494 | Providence Medical Group 9427 Sw Barnes Rd Suite 595 Portland OR 97225-6640 Ph: (503) 216-2346 |
| NPI Number | 1134351877 |
|---|---|
| Provider Enumeration Date | 08/13/2009 |
| Last Update Date | 07/04/2025 |
| Certification Date | 07/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134351877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
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