MEDICARE: FOREST GROVE PEDIATRICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1417167834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST GROVE PEDIATRICS PC

Provider Business Mailing Address
First Line	:	1911 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2382
Country	:	US
Telephone Number	:	503-359-1930
Fax Number	:	503-359-1985

Provider Business Practice Location Address
First Line	:	1911 MOUNTAIN VIEW LN
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2382
Country	:	US
Telephone Number	:	503-359-1930
Fax Number	:	503-359-1985

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. KATHERINE ROSE LONG
Credential	:	MD
Telephone Number	:	503-359-1930

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1316053499 — DR. ARCOMA LYNN GONZALEZ LAMBERT ND
Practice Location Address:

1911 MOUNTAIN VIEW LN , SUITE 300
FOREST GROVE, OR
97116-2382

Practice Phone: 503-357-2826
Practice Fax: 503-357-4831

1285717579 — MRS. DARCY CATHERINE CRUIKSHANK DMD MSD
Practice Location Address:

1911 MOUNTAIN VIEW LANE , #100
FOREST GROVE, OR
97116-2382

Practice Phone: 503-359-5408
Practice Fax: 503-359-0584

1396816542 — DR. CRYSTAL LYNNE HANNAN ND
Practice Location Address:

1911 MOUNTAIN VIEW LN , SUITE 200
FOREST GROVE, OR
97116-2382

Practice Phone: 503-357-3074
Practice Fax: 503-357-2527

1871760520 — BLOSSOMING HEALTH LLC
Practice Location Address:

2735 20TH PL , SUITE A
FOREST GROVE, OR
97116-2382

Practice Phone: 503-357-2826
Practice Fax: 503-357-4831

1902061336 — MR. DANIEL R CARSON
Practice Location Address:

1911 MOUNTAIN VIEW LN , SUITE 200
FOREST GROVE, OR
97116-2382

Practice Phone: 503-357-2827
Practice Fax: 503-357-4831

1558526913 — STEPHEN T ENSIGN LMT
Practice Location Address:

1911 MOUNTAIN VIEW LANE , SUITE 200
FOREST GROVE, OR
97116-2382

Practice Phone: 503-357-2826
Practice Fax: 503-357-4831

Directions to “FOREST GROVE PEDIATRICS PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.