Healthcare Provider Details

I. General information

NPI: 1285765883
Provider Name (Legal Business Name): PENDLETON FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SE COURT PL STE 201
PENDLETON OR
97801-3281
US

IV. Provider business mailing address

1600 SE COURT PL STE 201
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-1700
  • Fax:
Mailing address:
  • Phone: 541-276-1700
  • Fax: 541-276-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: BETHEL E HART
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-276-1700