Provider Demographics
NPI:1326210063
Name:PACIFIC OBSTETRICS & GYNECOLOGY, L.L.C.
Entity Type:Organization
Organization Name:PACIFIC OBSTETRICS & GYNECOLOGY, L.L.C.
Other - Org Name:LAVENA MORGAN, M.D., L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORGAN-JAHANSHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-485-5959
Mailing Address - Street 1:PO BOX 2082
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2082
Mailing Address - Country:US
Mailing Address - Phone:503-356-9166
Mailing Address - Fax:503-771-7221
Practice Address - Street 1:700 BELLEVUE ST SE STE 210
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3855
Practice Address - Country:US
Practice Address - Phone:503-485-5959
Practice Address - Fax:503-485-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21448207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151319Medicaid
ORR107569OtherGROUP PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
OR107569Medicare PIN
OR151319Medicaid