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PEDIATRIC SPECIALISTS OF PENDLETON LLC NPI 1689739310


NPI Information

NPI: 1689739310
Provider Name: PEDIATRIC SPECIALISTS OF PENDLETON, LLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 38D0628508

Address:
1600 SE COURT PL
SUITE, L01
PENDLETON, OR
ZIP 97801
Phone: (541) 276-0250
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PEDIATRIC SPECIALISTS OF PENDLETON, LLC is a clinic center in Pendleton, OR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PEDIATRIC SPECIALISTS OF PENDLETON, LLC NPI is 1689739310. The provider is registered as an organization entity type.

The provider's business location address is:

1600 SE COURT PL
SUITE, L01
PENDLETON, OR
ZIP 97801-281
Phone: (541) 276-0250
Fax: (541) 276-0253

The provider's authorized official is Donald Clifford Guenther .
The authorized official title is Manager and has the following contact phone number (541) 276-0250.

The CLIA number assigned to this NPI record is 38D0628508 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/22/2006 and was last updated on 11/23/2009.


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
1261Q00000XClinic/Center11027630OREGONYes

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
1288044MEDICAIDOREGON

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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