Healthcare Provider Details

I. General information

NPI: 1750488235
Provider Name (Legal Business Name): PEDIATRIC HEART CENTER OF CENTRAL OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701
US

IV. Provider business mailing address

2500 NE NEFF RD
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-7787
  • Fax: 541-322-2731
Mailing address:
  • Phone: 541-388-7787
  • Fax: 541-322-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLL10700
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier287314
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: DR. URSZULA TAJCHMAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 541-388-7787