Organization
FAMILY MEDICAL GROUP NORTHEAST, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEIRENE ADAMS (ADMINISTRATOR)
(503) 288-0083
Entity
Organization
Contact information
Practice address
2647 NE 33RD AVE, PORTLAND, OR 97212-3647
(503) 288-0083
(503) 288-7843
Mailing address
2647 NE 33RD AVE, PORTLAND, OR 97212-3647
(503) 288-0083
(503) 288-7843
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R000WCHMD
MEDICARE GROUP NUMBER
OR
Enumeration date
09/14/2007
Last updated
09/14/2007
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