1326210063 NPI number — PACIFIC OBSTETRICS & GYNECOLOGY, L.L.C.

Table of content: (NPI 1326210063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326210063 NPI number — PACIFIC OBSTETRICS & GYNECOLOGY, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC OBSTETRICS & GYNECOLOGY, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAVENA MORGAN, M.D., L.L.C.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326210063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2082
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-2082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-356-9166
Provider Business Mailing Address Fax Number:
503-771-7221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 BELLEVUE ST SE STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-3855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-485-5959
Provider Business Practice Location Address Fax Number:
503-485-5962
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN-JAHANSHIR
Authorized Official First Name:
LAVENA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
503-485-5959

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD21448 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151319 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: R107569 . This is a "GROUP PROVIDER TRANSACTION ACCESS NUMBER (PTAN)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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