Provider Demographics
NPI:1912226218
Name:ROSE CITY PEDIATRICS LLC
Entity Type:Organization
Organization Name:ROSE CITY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:HUFF-SLANKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:503-232-1392
Mailing Address - Street 1:3507 SE 36TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1862
Mailing Address - Country:US
Mailing Address - Phone:503-232-1392
Mailing Address - Fax:503-232-1345
Practice Address - Street 1:3507 SE 36TH AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1862
Practice Address - Country:US
Practice Address - Phone:503-232-1392
Practice Address - Fax:503-232-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR66678393261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care