Organization
HILLSBORO PEDIATRIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINGER MCDONALD CPA (CPA/ADMINISTRATOR)
(503) 640-2757
Entity
Organization
Contact information
Practice address
445 E MAIN ST, HILLSBORO, OR 97123-4084
(503) 640-2757
(503) 640-9753
Mailing address
445 E MAIN ST, HILLSBORO, OR 97123-4084
(503) 640-2757
(503) 640-9753
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022706
—
OR
01
—
023873000
BLUE CROSS GROUP ID
OR
01
—
1245312842
NPI
—
01
—
R163532
PTAN
—
Enumeration date
10/20/2006
Last updated
10/26/2020
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