Providence Medical Group Scholls | |
12442 Sw Scholls Ferry Rd Suite 100 Tigard OR 97223-3396 | |
(503) 216-9200 | |
(503) 216-9220 |
Full Name | Providence Medical Group Scholls |
---|---|
Speciality | Clinic/center |
Location | 12442 Sw Scholls Ferry Rd, Tigard, Oregon |
Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB) |
Authorized Official Contact | 4255255392 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Providence Medical Group Scholls Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Providence Medical Group Scholls 12442 Sw Scholls Ferry Rd Suite 100 Tigard OR 97223-3396 Ph: (503) 216-9200 |
NPI Number | 1093815243 |
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Provider Enumeration Date | 09/25/2006 |
Last Update Date | 06/17/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093815243 | NPI | - | NPPES |
063680 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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