Provider Demographics
NPI:1720377971
Name:PHYSICIAN DIRECTED SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICIAN DIRECTED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-218-9062
Mailing Address - Street 1:3030 SW 10TH AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3085
Mailing Address - Country:US
Mailing Address - Phone:971-218-9062
Mailing Address - Fax:
Practice Address - Street 1:3030 SW 10TH AVE APT 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3085
Practice Address - Country:US
Practice Address - Phone:971-218-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty