MEDICARE: ROSE CITY PEDIATRICS AND URGENT CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1699230979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE CITY PEDIATRICS AND URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	3507 SE 36TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1862
Country	:	US
Telephone Number	:	503-232-1392
Fax Number	:	503-232-1345

Provider Business Practice Location Address
First Line	:	3507 SE 36TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1862
Country	:	US
Telephone Number	:	503-232-1392
Fax Number	:	503-232-1345

Authorized Official
Title or Position	:	CO-OWNER/PCP
Name	:	DR. ROBERT SHANE ANTHONY FUCHS
Credential	:	DNP, FNP-C
Telephone Number	:	503-232-1392

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	01/31/2019

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