Organization
CHILDRENS CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY DURHAM (HEALTH PLAN COORDINATOR)
(503) 535-6314
Entity
Organization
Contact information
Practice address
700 DEBORAH RD, STE 150, NEWBERG, OR 97132-2198
(503) 538-6791
(503) 554-0549
Mailing address
700 DEBORAH RD, STE 150, NEWBERG, OR 97132-2198
(503) 538-6791
(503) 554-0549
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500730975
—
OR
Enumeration date
01/02/2017
Last updated
04/28/2020
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