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General NPI Number Information
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NPI Number | 1689739310
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALISTS OF PENDLETON, LLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 1600 SE COURT PL SUITE, L01
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City | PENDLETON
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State | OR
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Zip | 97801-3281
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Country | US
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Telephone | 541-276-0250
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Fax | 541-276-0253
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Provider Business Mailing Address
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Address Line | 1600 SE COURT PL SUITE, L01
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City | PENDLETON
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State | OR
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Zip | 97801-3281
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Country | US
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Telephone | 541-276-0250
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Fax | 541-276-0253
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DONALD CLIFFORD GUENTHER
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Credential | MD
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Telephone | 541-276-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 11027630
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License Number State | OR
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