1790937613 NPI number — MISS SARAH CHRISTINE SIMONS PA-C

Table of content: MISS SARAH CHRISTINE SIMONS PA-C (NPI 1790937613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790937613 NPI number — MISS SARAH CHRISTINE SIMONS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONS
Provider First Name:
SARAH
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEISCHMAN
Provider Other First Name:
SARAH
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790937613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9555 SW BARNES RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97225-6663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-297-7403
Provider Business Mailing Address Fax Number:
503-384-9908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9555 SW BARNES RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-7403
Provider Business Practice Location Address Fax Number:
503-384-9908
Provider Enumeration Date:
10/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA05213 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA165017 , 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)