Individual ProviderJohn David KinziePsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011(503) 494-8617(503) 494-6148PECOS EnrollmentThis provider is enrolled in PECOS as JOHN KINZIE.Based on the most recent information from CMS, provider John David Kinzie is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1962417469Provider TypeIndividualFull NameKinzie, John DavidCredentialMDGenderMaleSole ProprietorNoEnumeration Date7/31/2006Last Updated9/21/2011Contact InformationPractice LocationPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(503) 494-8617FaxUnlisted FaxMailing LocationMailing Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(503) 494-6148FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseMD10390OregonProvider IdentifiersIDDescriptionIssuerID246264DescriptionMedicaidIssuerUnlistedOregon