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Organization

PACIFIC HEART ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MANDY BOUSCHOR (BILLING SUPERVISOR)
(503) 790-0230
Entity
Organization

Contact information

Practice address
174 FIRST AVE N, ILWACO, WA 98624
(888) 414-7558
Mailing address
1040 NW 22ND AVE, SUITE 660, PORTLAND, OR 97210-3057
(503) 790-1234

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
287001
OR
05
7111966
WA
Enumeration date
07/09/2008
Last updated
07/09/2008
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