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OLSON PEDIATRIC CLINIC LLC NPI 1588902902


NPI Information

NPI: 1588902902
Provider Name: OLSON PEDIATRIC CLINIC, LLC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 38D2175852

Address:
16463 BOONES FERRY RD
SUITE 400
LAKE OSWEGO, OR
ZIP 97035
Phone: (503) 635-3743
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OLSON PEDIATRIC CLINIC, LLC is an adolescent medicine pediatrics in Lake Oswego, OR. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. OLSON PEDIATRIC CLINIC, LLC NPI is 1588902902. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

16463 BOONES FERRY RD
SUITE 400
LAKE OSWEGO, OR
ZIP 97035-259
Phone: (503) 635-3743
Fax: (503) 636-7404

The provider's authorized official is Elizabeth Graff .
The authorized official title is Physician and has the following contact phone number (503) 635-3743.

The CLIA number assigned to this NPI record is 38D2175852 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2013 and was last updated on 1/18/2013.


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
12080A0000XPediatricsAdolescent MedicineYes

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: 5/5/2024

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