Newberg Pediatric Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD10760 Issued in OR

Legal business name

NEWBERG PEDIATRIC CLINIC

Practice address

308 Villa Rd Ste 116
Newberg, OR 97132-1881

Phone

(503) 538-7407

Fax

(503) 537-0640

NPI assigned

Jul 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Maya Jane Manka, M.D.NPI 1316982242

Title

Owner

Phone

(503) 538-7407

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maya Jane Manka, M.D.

  • Specialist
  • Newberg, OR
  • NPI 1316982242
  NPD (past) Authorized official
• Ronald Eugene Culver, MD

  • Pediatrics Physician
  • Newberg, OR
  • NPI 1205889391
  NPD (past)

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1306001615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 VILLA RD STE 116",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971321881",
            "telephone_number": "503-538-7407",
            "fax_number": "503-537-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 VILLA RD STE 116",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971321881",
            "telephone_number": "503-538-7407",
            "fax_number": "503-537-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWBERG PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "MANKA",
        "authorized_official_first_name": "MAYA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-538-7407",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD10760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126565",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Newberg School District 29J
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• Newberg Urgent Care and Medical Center
• Newberg Urgent Care and Medical Center

• Specialist in Newberg, OR
• Providers in Newberg, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.