Pacific Heart Associates PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PACIFIC HEART ASSOCIATES PC

Practice address

174 First Ave N
Ilwaco, WA 98624

Phone

(888) 414-7558

NPI assigned

Jul 9, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Mandy Bouschor

Title

Billing Supervisor

Phone

(503) 790-0230

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1487817508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE",
            "address_2": "SUITE 660",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103057",
            "telephone_number": "503-790-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 FIRST AVE N",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "98624",
            "telephone_number": "888-414-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HEART ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "BOUSCHOR",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "503-790-0230",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287001",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7111966",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ocean Beach Chiropractic PS
• Ocean Beach Physical Therapy Inc
• Ocean Beach School District
• Colin Irvin Holganza Ortiz, PT
• Jacob Owings, PHARMD
• Peninsula Pharmacies Inc
• Peninsula Pharmacies Inc.
• Providence Health & Services - Oregon
• Shirley M Pryor, ARNP
• Public Hospital District 3 of Pacific County

• Specialist in Ilwaco, WA
• Providers in Ilwaco, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.