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NORTHWEST PEDIATRIC CRITICAL CARE PC NPI 1013954189


NPI Information

NPI: 1013954189
Provider Name: NORTHWEST PEDIATRIC CRITICAL CARE PC
Classification: Pediatrics - 2080P0203X
Entity Type: Organization

Specialization: Pediatric Critical Care Medicine

CLIA Number: 38D0964893

Address:
2801 N GANTENBEIN AVE
PORTLAND, OR
ZIP 97227
Phone: (503) 413-2794
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NORTHWEST PEDIATRIC CRITICAL CARE PC is a pediatric critical care medicine pediatrics in Portland, OR. The provider is a pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. NORTHWEST PEDIATRIC CRITICAL CARE PC NPI is 1013954189. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2801 N GANTENBEIN AVE
PORTLAND, OR
ZIP 97227
Phone: (503) 413-2794
Fax: (503) 413-6449

The provider's authorized official is Christopher Phillips .
The authorized official title is Billing Manager and has the following contact phone number (360) 567-3284.

The CLIA number assigned to this NPI record is 38D0964893 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/31/2006 and was last updated on 7/3/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080P0203XPediatricsPediatric Critical Care MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1R100739MEDICARE PINOREGON
2051895000OTHEROREGONBLUE CROSS
37085467MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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