Provider Demographics
NPI:1730252487
Name:J C PITTS ENTERPRISES INC
Entity type:Organization
Organization Name:J C PITTS ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-377-3937
Mailing Address - Street 1:251 SW 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1972
Mailing Address - Country:US
Mailing Address - Phone:541-889-3198
Mailing Address - Fax:208-377-9455
Practice Address - Street 1:251 SW 19TH STREET
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1972
Practice Address - Country:US
Practice Address - Phone:541-889-3198
Practice Address - Fax:208-377-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071506ASC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100783000OtherBLUE CROSS OREGON
OR135876Medicaid
P051001OtherPACIFIC SOURCE
OR100783000OtherBLUE CROSS
ID000010019705OtherBLUE SHIELD
IDBMUY9OtherBLUE CROSS
ID003419300Medicaid
OR135876Medicaid
P051001OtherPACIFIC SOURCE
OR0000DBCBLMedicare PIN