MEDICARE: RAM CLINIC 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	261QM2800X	Methadone Clinic		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	170140	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1992897193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAM CLINIC INC.

Provider Business Mailing Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5120
Country	:	US
Telephone Number	:	503-408-9585
Fax Number	:	503-408-9456

Provider Business Practice Location Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5120
Country	:	US
Telephone Number	:	503-408-9585
Fax Number	:	503-408-9456

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	VICCIE BOECKEL
Credential	:	CDAC2
Telephone Number	:	503-408-9585

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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