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NPI Code Detail

MEDICARE: MICHAEL IRVIN

MEDICARE: MICHAEL IRVIN
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
1314000000XSkilled Nursing Facility09071OR

General Provider Information

NPI Number : 1154738391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL IRVIN
Provider Business Mailing Address
First Line : 1425 NE MASON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97211-5143
Country : US
Telephone Number : 503-453-4996
Fax Number :
Provider Business Practice Location Address
First Line : 6010 SW SHATTUCK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97221-1043
Country : US
Telephone Number : 503-246-8811
Fax Number : 503-246-9557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 07/21/2014

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Directions to “ MICHAEL IRVIN ” Practice Location

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