Individual provider Active NPI

Eve Koltuv, M.D.

  • Pediatrics Physician
  • La Grande, OR
National Provider Identifier
1043631708
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD186875 Issued in OR
Practice address
710 Sunset Dr Ste E
La Grande, OR 97850-1200
Phone
(541) 663-3150
Fax
(541) 975-5111
NPI assigned
Dec 26, 2013
Last updated
Aug 29, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 276540 NY
Pediatrics Physician 208000000X MD186875 OR Primary

Addresses

Primary practice location

710 Sunset Dr Ste E
La Grande, OR 97850-1200

Mailing address

PO Box 3290
La Grande, OR 97850-7290
Phone (541) 963-1967

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191115000720 OR Practitioner - Pediatric Medicine 5395177133 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
276540NYMDPediatrics Physician
MD186875ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Ronde Hospital, Inc. CurrentSince Oct 15, 2019 Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince Oct 15, 2019 Accepting new patients

Locations

710 Sunset Dr
Ste E
La Grande, OR 97850
Phone (541) 663-3150

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1043631708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3290",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978507290",
            "telephone_number": "541-963-1967",
            "fax_number": "541-963-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 SUNSET DR STE E",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501200",
            "telephone_number": "541-663-3150",
            "fax_number": "541-975-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLTUV",
        "first_name": "EVE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-26",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "276540",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD186875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.