Provider Demographics
NPI:1124070701
Name:PACIFIC FAMILY MEDICINE LLP
Entity type:Organization
Organization Name:PACIFIC FAMILY MEDICINE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-325-5300
Mailing Address - Street 1:2055 EXCHANGE ST
Mailing Address - Street 2:STE 190
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3419
Mailing Address - Country:US
Mailing Address - Phone:503-325-5300
Mailing Address - Fax:503-325-5400
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:STE 190
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-325-5300
Practice Address - Fax:503-325-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110761Medicare ID - Type Unspecified