MEDICARE: DR. RICHARD C MANTHEY MD

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	207P00000X	Emergency Medicine Physician	MD.018258	LA
2	207R00000X	Internal Medicine Physician	MD28549	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00893292	OTHER	OR	RR MEDICARE - PHS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MD28549	OTHER	OR	LICENSE

General Provider Information

NPI Number	:	1639120314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C MANTHEY MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:	503-215-6644

Provider Business Practice Location Address
First Line	:	1321 NE 99TH AVE
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97220-9436
Country	:	US
Telephone Number	:	503-215-9900
Fax Number	:	503-215-4025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/22/2021

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Directions to “ DR. RICHARD C MANTHEY MD” Practice Location

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