Healthcare Provider Details

I. General information

NPI: 1427008614
Provider Name (Legal Business Name): ASHLAND PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAPLE ST
ASHLAND OR
97520-1516
US

IV. Provider business mailing address

1208 BEALL LN
CENTRAL POINT OR
97502-1573
US

V. Phone/Fax

Practice location:
  • Phone: 541-482-8114
  • Fax:
Mailing address:
  • Phone: 541-664-5151
  • Fax: 541-664-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANE C WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 541-482-8114