Provider Demographics
NPI:1164600243
Name:NORTHWEST GYNECOLOGY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:NORTHWEST GYNECOLOGY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREVANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-3854
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-1719
Mailing Address - Country:US
Mailing Address - Phone:503-352-3854
Mailing Address - Fax:503-924-2769
Practice Address - Street 1:4660 NE BELKNAP CT STE 109
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8402
Practice Address - Country:US
Practice Address - Phone:503-352-3854
Practice Address - Fax:503-924-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR119335Medicare PIN