Provider Demographics
NPI:1720722051
Name:PACIFIC HEALTHCARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:PACIFIC HEALTHCARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEANE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WADSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-312-2279
Mailing Address - Street 1:6107 SW MURRAY BLVD STE 516
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4421
Mailing Address - Country:US
Mailing Address - Phone:503-956-9432
Mailing Address - Fax:
Practice Address - Street 1:14355 SW ALLEN BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4700
Practice Address - Country:US
Practice Address - Phone:503-956-9432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1639113590OtherNPI