MEDICARE: ROSE CITY PEDIATRICS 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	261QP2300X	Primary Care Clinic/Center	66678393	OR

General Provider Information

NPI Number	:	1912226218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE CITY PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	3507 SE 36TH AVENUE
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 AVENUE
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	:	PEDIATRIC NURSE PRACTITIONER
Name	:	DR. JANIE LOU HUFF-SLANKARD
Credential	:	D.N.P.
Telephone Number	:	503-232-1392

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/31/2011

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Directions to “ROSE CITY PEDIATRICS LLC ” Practice Location

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