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John Mark Kinzie

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

3181 SW Sam Jackson Park Rd, Uhn 80, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as JOHN KINZIE.

Based on the most recent information from CMS, provider John Mark Kinzie is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1386652840
Provider Type
Individual
Full Name
Kinzie, John Mark
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
8/3/2006
Last Updated
7/13/2007

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Uhn 80, Portland, OR 97239-3011

(503) 494-8617

Unlisted Fax

Mailing Location

3181 SW Sam Jackson Park Rd, Ohsu/ Uhn 80t, Portland, OR 97239-3011

(503) 418-1608

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License MD24995 Oregon

Provider Identifiers

ID	Description	Issuer
ID 022453	Description Medicaid	Issuer Unlisted Oregon

John Mark Kinzie

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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