Provider Demographics
NPI:1164947701
Name:PACIFIC CREST CHILDRENS URGENT CARE LLC
Entity Type:Organization
Organization Name:PACIFIC CREST CHILDRENS URGENT CARE LLC
Other - Org Name:BRAVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:ADAIR
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-963-7963
Mailing Address - Street 1:6924 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5256
Mailing Address - Country:US
Mailing Address - Phone:503-300-4111
Mailing Address - Fax:503-954-2122
Practice Address - Street 1:6924 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5256
Practice Address - Country:US
Practice Address - Phone:503-300-4111
Practice Address - Fax:503-954-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty