WILLAMETTE FALLS PEDIATRIC GROUP PC NPI 1528220936

NPI Information

  • NPI: 1528220936
  • Provider Name: WILLAMETTE FALLS PEDIATRIC GROUP, PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 38D1085078
  • Address: 200 SOUTH HAZEL DELL WAY
    SUITE 202
    CANBY, OR
    ZIP 97013
  • Phone: (503) 266-8500

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NPI Details

WILLAMETTE FALLS PEDIATRIC GROUP, PC is a pediatrics in Canby, OR. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. WILLAMETTE FALLS PEDIATRIC GROUP, PC NPI is 1528220936. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

200 SOUTH HAZEL DELL WAY
SUITE 202
CANBY, OR
ZIP 97013
Phone: (503) 266-8500
Fax: (503) 266-8585

The provider's authorized official is Christina Marie Grucella .
The authorized official title is President and has the following contact phone number (503) 905-3400.

The CLIA number assigned to this NPI record is 38D1085078 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/26/2008 and was last updated on 6/26/2008.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics1292945-0OREGONYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1028484MEDICAIDOREGON

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: 11/21/2025

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