Provider Demographics
NPI:1861549131
Name:COLUMBIA PACIFIC UROLOGY
Entity type:Organization
Organization Name:COLUMBIA PACIFIC UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:LEIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-325-7888
Mailing Address - Street 1:2120 EXCHANGE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3366
Mailing Address - Country:US
Mailing Address - Phone:503-325-7888
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST STE 102
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Not Answered2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079116Medicaid
OR079116Medicaid
ORE08735Medicare UPIN