Individual ProviderJonathan WilsonPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011(503) 494-8211PECOS EnrollmentBased on the most recent information from CMS, provider Jonathan Wilson 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 2 days ago.Profile DetailsProvider ID1861887549Provider TypeIndividualFull NameWilson, JonathanGenderMaleSole ProprietorNoEnumeration Date3/31/2015Last Updated10/2/2017Contact InformationPractice LocationPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(503) 494-8211FaxUnlisted FaxMailing LocationMailing Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(503) 494-8211FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseMD182061OregonCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer