MEDICARE: RICHARD C. PADGETT M.D.

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	207RC0000X	Cardiovascular Disease Physician	MD21059	OR

General Provider Information

NPI Number	:	1679571814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD C. PADGETT M.D.

Provider Business Mailing Address
First Line	:	1115 SE 164TH AVE DEPT 358
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-8004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 RIVER BEND DRIVE
Second Line	:	SUITE 300
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-484-4332
Fax Number	:	541-242-6770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/03/2016

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