MEDICARE: OAK GROVE FAMILY MEDICAL CLINIC P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CF9670	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A001	OTHER	OR	CHAMPUS
3	067039000	OTHER	OR	BLUE CROSS

General Provider Information

NPI Number	:	1346218369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK GROVE FAMILY MEDICAL CLINIC P C

Provider Business Mailing Address
First Line	:	2250 SE OAK GROVE BLVD STE B
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2670
Country	:	US
Telephone Number	:	503-654-6567
Fax Number	:	503-653-2582

Provider Business Practice Location Address
First Line	:	2250 SE OAK GROVE BLVD #B
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2670
Country	:	US
Telephone Number	:	503-654-6567
Fax Number	:	503-653-2582

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. CAROLYN J BELL
Credential	:
Telephone Number	:	503-653-1860

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	10/01/2025

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Directions to “OAK GROVE FAMILY MEDICAL CLINIC P C ” Practice Location

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