Provider Demographics
NPI:1275061681
Name:PACIFIC NW FAMILY PRACTICE, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:PACIFIC NW FAMILY PRACTICE, LIMITED LIABILITY COMPANY
Other - Org Name:PACIFIC NW FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:503-648-1003
Mailing Address - Street 1:256 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4017
Mailing Address - Country:US
Mailing Address - Phone:503-648-1003
Mailing Address - Fax:503-648-1013
Practice Address - Street 1:256 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4017
Practice Address - Country:US
Practice Address - Phone:503-648-1003
Practice Address - Fax:503-648-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01299261QP2300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care