MEDICARE: VIRGINIA GARCIA MEMORIAL HEALTH CENTER

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1063067312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA GARCIA MEMORIAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 6149
Second Line	:
City	:	ALOHA
State	:	OR
Zip	:	97007-0149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11300 SW HAZELBROOK RD
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-6980
Country	:	US
Telephone Number	:	503-431-5100
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MRS. MARIA E LOREDO
Credential	:
Telephone Number	:	503-359-8502

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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