Pendleton Family Practice and Sports Medicine LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

DO20295 Issued in OR

Legal business name

PENDLETON FAMILY PRACTICE AND SPORTS MEDICINE LLC

Practice address

202 SE Dorion Ave
Pendleton, OR 97801-2576

Phone

(541) 966-8384

Fax

(541) 966-8387

NPI assigned

Feb 20, 2018

Organization subpart

No

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

Authorized official

Name

Darla Linker

Title

Office Manager

Phone

(541) 966-8384

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Kent R. Walker, D.O. Former legal business name

Locations

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1225538796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 SE DORION AVE",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978012576",
            "telephone_number": "541-966-8384",
            "fax_number": "541-966-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SE DORION AVE",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978012576",
            "telephone_number": "541-966-8384",
            "fax_number": "541-966-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON FAMILY PRACTICE AND SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "LINKER",
        "authorized_official_first_name": "DARLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-966-8384"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "DO20295",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "DO20295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150117",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Kent R. Walker, D.O.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pendleton Primary Care Clinic LLC
• Pendleton Ventures LLC
• Leighton T Pennington

• Primary Care Clinic/Center in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.