Basic Information
| Provider Information | |||||||||
| NPI: | 1740411800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST ANTHONY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST ANTHONY CHILDREN'S CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 SE COURT AVE | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412765121 | ||||||||
| FaxNumber: | 5412783227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 SE COURT AVE | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412765121 | ||||||||
| FaxNumber: | 5412783227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 08/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHLENKER | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5412783220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST ANTHONY HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.