Healthcare Provider Details

I. General information

NPI: 1144287541
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY CENTER OF OREGON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRAHAM ST SUITE 250
PORTLAND OR
97227-1683
US

IV. Provider business mailing address

PO BOX 821350
VANCOUVER WA
98682-0030
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-3418
  • Fax: 503-284-7885
Mailing address:
  • Phone: 503-280-3418
  • Fax: 503-284-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L. LAMB
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 503-280-3418