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General NPI Number Information
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NPI Number | 1174488787
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 7150 SW DARTMOUTH ST
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City | TIGARD
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State | OR
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Zip | 97223-7614
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Country | US
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Telephone | 503-968-3480
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Fax | 503-227-4589
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Provider Business Mailing Address
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Address Line | 7150 SW DARTMOUTH ST
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City | TIGARD
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State | OR
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Zip | 97223-7614
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Country | US
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Telephone | 503-968-3480
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Fax | 503-227-4589
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JILL EWANCHUK
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Credential |
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Telephone | 503-227-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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