Healthcare Provider Details

I. General information

NPI: 1689739310
Provider Name (Legal Business Name): PEDIATRIC SPECIALISTS OF PENDLETON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SE COURT PL SUITE, L01
PENDLETON OR
97801-3281
US

IV. Provider business mailing address

1600 SE COURT PL SUITE, L01
PENDLETON OR
97801-3281
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-0250
  • Fax: 541-276-0253
Mailing address:
  • Phone: 541-276-0250
  • Fax: 541-276-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11027630
License Number StateOR

VIII. Authorized Official

Name: DR. DONALD CLIFFORD GUENTHER
Title or Position: MANAGER
Credential: MD
Phone: 541-276-0250