| Providence St Vincent Heart Clinics Cardiology Portland Clinic Beavert | |
|
15950 Sw Millikan Way Beaverton OR 97003-5170 | |
| (503) 297-6234 | |
| Not Available |
| Full Name | Providence St Vincent Heart Clinics Cardiology Portland Clinic Beavert |
|---|---|
| Speciality | Clinic/center |
| Location | 15950 Sw Millikan Way, Beaverton, Oregon |
| Authorized Official Name and Position | Keenan B Freeman (CFO) |
| Authorized Official Contact | 5038936524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence St Vincent Heart Clinics Cardiology Portland Clinic Beavert Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence St Vincent Heart Clinics Cardiology Portland Clinic Beavert 15950 Sw Millikan Way Beaverton OR 97003-5170 Ph: (503) 297-6234 |
| NPI Number | 1790096873 |
|---|---|
| Provider Enumeration Date | 06/23/2010 |
| Last Update Date | 12/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790096873 | NPI | - | NPPES |
| 500628337 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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