Basic Information
| Provider Information | |||||||||
| NPI: | 1285765883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENDLETON FAMILY MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 SE COURT PL | ||||||||
| Address2: | STE 201 | ||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412761700 | ||||||||
| FaxNumber: | 5412766327 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SE COURT PL | ||||||||
| Address2: | STE 201 | ||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412761700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | HART | ||||||||
| AuthorizedOfficialFirstName: | BETHEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5412761700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.