Healthcare Provider Details

I. General information

NPI: 1437970480
Provider Name (Legal Business Name): STEVEN MCBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HAILEY AVE STE 204
PENDLETON OR
97801-3072
US

IV. Provider business mailing address

PO BOX 882
PENDLETON OR
97801-0882
US

V. Phone/Fax

Practice location:
  • Phone: 541-663-4104
  • Fax:
Mailing address:
  • Phone: 541-663-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-CRM-3171
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: