Healthcare Provider Details

I. General information

NPI: 1275576050
Provider Name (Legal Business Name): COLUMBIA CARDIOLOGY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PROVIDENCE DRIVE SUITE 325
NEWBERG OR
97132-1886
US

IV. Provider business mailing address

PO BOX 4100 MS 12
PORTLAND OR
97208-4100
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-1187
  • Fax: 503-554-8486
Mailing address:
  • Phone: 503-297-6234
  • Fax: 503-297-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JEFF FRY
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 503-297-6234