Provider Demographics
NPI:1457337834
Name:CENTRAL OREGON PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL OREGON PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:541-389-6313
Mailing Address - Street 1:2200 NE PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6063
Mailing Address - Country:US
Mailing Address - Phone:541-389-6313
Mailing Address - Fax:541-389-8760
Practice Address - Street 1:2200 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6063
Practice Address - Country:US
Practice Address - Phone:541-389-6313
Practice Address - Fax:541-389-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty