Provider Demographics
NPI:1083716401
Name:PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Other - Org Name:PNRS TWIN OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:15201 NW GREENBRIER PKWY STE C2
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6004
Mailing Address - Country:US
Mailing Address - Phone:503-690-4883
Mailing Address - Fax:503-690-3020
Practice Address - Street 1:15201 NW GREENBRIER PKWY STE C2
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6004
Practice Address - Country:US
Practice Address - Phone:503-690-4883
Practice Address - Fax:503-690-3020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR382525Medicare Oscar/Certification