| Organization Name: | TILLAMOOK SPECIALIST ASSOCIATES, LLC |
| NPI Number: | 1154443646 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SID RITTENBACH (ADMINISTRATOR) |
| Mailing Address: | 980 3rd St Suite 500 Tillamook |
| State: | OR US |
| Postal Code: | 971419469 |
| Phone Number: | 5038425546 |
| Fax Number: | 5038421444 |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 12/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |