=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649289851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIAN'S PRIMARY CARE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 S.W. 13TH ST.
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-889-8410
-----------------------------------------------------
Fax | 541-889-8093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 S.W. 13TH ST.
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-889-8410
-----------------------------------------------------
Fax | 541-889-8093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. PAUL J SNYDER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-889-8410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------