Provider Demographics
NPI:1912997750
Name:PENDLETON INTERNAL MEDICINE SPECIALISTS PC
Entity Type:Organization
Organization Name:PENDLETON INTERNAL MEDICINE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-276-1911
Mailing Address - Street 1:1100 SOUTHGATE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3974
Mailing Address - Country:US
Mailing Address - Phone:541-276-1911
Mailing Address - Fax:541-276-3577
Practice Address - Street 1:1100 SOUTHGATE
Practice Address - Street 2:SUITE #2
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3974
Practice Address - Country:US
Practice Address - Phone:541-276-1911
Practice Address - Fax:541-276-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00WCGNWAMedicare ID - Type Unspecified
ORD73144Medicare UPIN