MEDICARE: CENTRAL CITY CONCERN, INC.

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	:	1982382594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CITY CONCERN, INC.

Provider Business Mailing Address
First Line	:	232 NW 6TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-3609
Country	:	US
Telephone Number	:	503-294-1681
Fax Number	:

Provider Business Practice Location Address
First Line	:	5019 NE 102ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-1199
Country	:	US
Telephone Number	:	971-383-1220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. ANDREW B MENDENHALL
Credential	:	MD
Telephone Number	:	413-584-2173

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	03/11/2026

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