Provider Demographics
NPI:1447381157
Name:PACIFIC HEART ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PACIFIC HEART ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSCHOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-790-0230
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:SUITE 660
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-790-1234
Mailing Address - Fax:503-790-0234
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-692-0405
Practice Address - Fax:503-692-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty