Provider Demographics
NPI:1275576050
Name:COLUMBIA CARDIOLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:COLUMBIA CARDIOLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-297-6234
Mailing Address - Street 1:PO BOX 4100
Mailing Address - Street 2:MS 12
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4100
Mailing Address - Country:US
Mailing Address - Phone:503-297-6234
Mailing Address - Fax:503-297-4929
Practice Address - Street 1:1003 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1886
Practice Address - Country:US
Practice Address - Phone:503-554-1187
Practice Address - Fax:503-554-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR114233Medicare PIN