Pediatric Intensive Care Trauma Associates PC

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

Legal business name

PEDIATRIC INTENSIVE CARE TRAUMA ASSOCIATES PC

Practice address

2801 N Gantenbein Ave
Portland, OR 97227-1623

Phone

(866) 622-2455

NPI assigned

Sep 18, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Christopher Phillips, CPC

Title

Billing Manager

Phone

(360) 667-3047

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1083863682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 821350",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986820030",
            "telephone_number": "866-622-2455",
            "fax_number": "360-666-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "866-622-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC INTENSIVE CARE TRAUMA ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-18",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "360-667-3047",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Critical Care Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.