Provider Demographics
NPI:1528066859
Name:PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-419-4940
Mailing Address - Street 1:2701 NW VAUGHN ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-227-0671
Mailing Address - Fax:503-227-0676
Practice Address - Street 1:14795 SW MURRAY SCHOOLS DR.
Practice Address - Street 2:SUITE 121
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007
Practice Address - Country:US
Practice Address - Phone:503-673-1071
Practice Address - Fax:503-227-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR646412208000000X
OR2000742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty