Provider Demographics
NPI:1508033994
Name:NORTHWEST INTEGRATIVE HEALTH CENTER PC
Entity Type:Organization
Organization Name:NORTHWEST INTEGRATIVE HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-476-3182
Mailing Address - Street 1:201 N MERIDIAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2752
Mailing Address - Country:US
Mailing Address - Phone:503-476-3182
Mailing Address - Fax:
Practice Address - Street 1:201 N MERIDIAN ST STE B
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2752
Practice Address - Country:US
Practice Address - Phone:503-476-3182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
OR1539175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty