1144287541 NPI number — PEDIATRIC CARDIOLOGY CENTER OF OREGON PC

Table of content: (NPI 1144287541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144287541 NPI number — PEDIATRIC CARDIOLOGY CENTER OF OREGON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC CARDIOLOGY CENTER OF OREGON PC
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:
Provider Other Organization Name Type Code:
6
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:
1144287541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 821350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-280-3418
Provider Business Mailing Address Fax Number:
503-284-7885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N GRAHAM ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-280-3418
Provider Business Practice Location Address Fax Number:
503-284-7885
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAMB
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
BUSINESS ADMINISTRATOR
Authorized Official Telephone Number:
503-280-3418

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000WFBXL . This is a "MEDICARE ID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 057775000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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