Provider Demographics
NPI:1871663195
Name:JEFFREY C PITTS
Entity Type:Organization
Organization Name:JEFFREY C PITTS
Other - Org Name:ONTARIO MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-889-3106
Mailing Address - Street 1:269 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1972
Mailing Address - Country:US
Mailing Address - Phone:541-889-3106
Mailing Address - Fax:541-889-3904
Practice Address - Street 1:269 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1972
Practice Address - Country:US
Practice Address - Phone:541-889-3106
Practice Address - Fax:541-889-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13467207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026523Medicaid
180001596OtherRR MEDICARE
ID52290OtherBC
OR840399000OtherBC
ID000010008479OtherBS
OR2507OtherSAIF
ID8074625Medicaid
0905376OtherCHAMPUS
180001596OtherRR MEDICARE
0905376OtherCHAMPUS