MEDICARE: KIONA P COLEMAN 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	207Q00000X	Family Medicine Physician	MD228947	OR
2	207Q00000X	Family Medicine Physician	Q6167	TX
3	207Q00000X	Family Medicine Physician	BP10046112	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	476950YN3X	OTHER	TX	MEDICARE
6	P01844883	OTHER	TX	RAIL ROAD MEDICARE
8	P01617616	OTHER	TX	RAIL ROAD MEDICARE
15	P01618252	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-2616977-001	OTHER	TX	TRICARE
2	8FS771	OTHER	TX	BCBS
4	75-2616977-113	OTHER	TX	TRICARE
5	75-2771569-008	OTHER	TX	TRICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	8FS774	OTHER	TX	BCBS
11	75-2616977-002	OTHER	TX	TRICARE
12	8GW409	OTHER	TX	BCBS
13	75-2616977-028	OTHER	TX	TRICARE
14	75-2616977-066	OTHER	TX	TRICARE

General Provider Information

NPI Number	:	1861830408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIONA P COLEMAN MD

Provider Business Mailing Address
First Line	:	1350 NE 122ND AVE STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-2011
Country	:	US
Telephone Number	:	503-408-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 NE 122ND AVE STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-2011
Country	:	US
Telephone Number	:	503-408-7010
Fax Number	:	503-408-7035

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	05/20/2026

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1174588693 — SHUGANG GE MD
Practice Location Address:

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1356306575 — IMELDA C KELLY MD
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1841207206 — GREGORY CLARK SCRIBNER M.D.
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Directions to “ KIONA P COLEMAN MD” Practice Location

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