Provider Demographics
NPI:1609195528
Name:PDH FAMILY MEDICAL, PC
Entity Type:Organization
Organization Name:PDH FAMILY MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HURSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-399-7474
Mailing Address - Street 1:581 LANCASTER DR SE # 288
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5642
Mailing Address - Country:US
Mailing Address - Phone:503-399-7474
Mailing Address - Fax:503-399-0679
Practice Address - Street 1:608 LANCASTER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5643
Practice Address - Country:US
Practice Address - Phone:503-399-7474
Practice Address - Fax:503-399-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26240261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35433Medicare UPIN