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General NPI Number Information
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NPI Number | 1245312842
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Entity Type | Organization
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Legal Business Name | HILLSBORO PEDIATRIC CLINIC LLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 445 E MAIN ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4084
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Country | US
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Telephone | 503-640-2757
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Fax | 503-640-9753
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Provider Business Mailing Address
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Address Line | 445 E MAIN ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4084
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Country | US
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Telephone | 503-640-2757
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Fax | 503-640-9753
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Authorized Official
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Title or Position | CPA/ADMINISTRATOR
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Name | GINGER MCDONALD
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Credential | CPA
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Telephone | 503-640-2757
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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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