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General NPI Number Information
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NPI Number | 1558806406
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Entity Type | Organization
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Legal Business Name | CHILDRENS CLINIC PC
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 700 DEBORAH RD STE 150
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City | NEWBERG
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State | OR
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Zip | 97132-2198
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Country | US
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Telephone | 503-538-6791
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Fax | 503-554-0549
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Provider Business Mailing Address
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Address Line | 700 DEBORAH RD STE 150
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City | NEWBERG
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State | OR
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Zip | 97132-2198
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Country | US
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Telephone | 503-538-6791
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Fax | 503-554-0549
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Authorized Official
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Title or Position | HEALTH PLAN COORDINATOR
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Name | KELSEY DURHAM
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Credential |
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Telephone | 503-535-6314
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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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