Pediatric Cardiology Center of Oregon PC

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

Legal business name

PEDIATRIC CARDIOLOGY CENTER OF OREGON PC

Practice address

971 11TH Ave
Longview, WA 98632-2503

Phone

(360) 667-3049

Fax

(360) 666-0466

NPI assigned

Mar 9, 2011

Organization subpart

No

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

Authorized official

Name

Amanda L. Lamb

Title

Business Administrator

Phone

(503) 280-3418

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1528366986",
    "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": "360-667-3049",
            "fax_number": "360-666-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322503",
            "telephone_number": "360-667-3049",
            "fax_number": "360-666-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARDIOLOGY CENTER OF OREGON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-09",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "LAMB",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "503-280-3418"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "WA",
            "license": "MD00026664",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE CROSS BLUE SHIELD OF OREGON",
            "identifier": "057775000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231812",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peacehealth (St John Medical Center - Outpatient Therapies)
• Peacehealth St John Medical Center
• Tia Pearrow
• Diana Carole Pearson, BA
• Michael Pearson, AAC
• Pediatric Clinic, Inc., P.S.
• Kortnie Victoria Pena
• Angela Diane Pence, MSW, LICSW, DMHP
• Austyn Pence
• Gary Elliot Penner, MD

• Pediatric Cardiology Physician in Longview, WA
• Providers in Longview, WA by specialty
• Pediatric Cardiology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.