Provider Demographics
NPI:1669794541
Name:OREGON PEDIATRICS - HAPPY VALLEY, PC
Entity type:Organization
Organization Name:OREGON PEDIATRICS - HAPPY VALLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:KIRIT
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-659-1694
Mailing Address - Street 1:15970 SE MISTY DR # 100
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4368
Mailing Address - Country:US
Mailing Address - Phone:503-659-1694
Mailing Address - Fax:503-659-8984
Practice Address - Street 1:15970 SE MISTY DR., #100
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4368
Practice Address - Country:US
Practice Address - Phone:503-659-1694
Practice Address - Fax:503-659-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500632424Medicaid