Individual ProviderMolly AndersonPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239(503) 494-4910PECOS EnrollmentBased on the most recent information from CMS, provider Molly Anderson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1003388851Provider TypeIndividualFull NameAnderson, MollyCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date12/18/2018Last Updated1/15/2021Contact InformationPractice LocationPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239Phone(503) 494-4910FaxUnlisted FaxMailing LocationMailing Address3181 SW Sam Jackson Park Rd, Mail Code Sjh-2, Portland, OR 97239-3011Phone(503) 494-4910Fax(503) 494-8368Provider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA194571Oregon