Provider Demographics
NPI:1588674279
Name:NORTHWEST MEDICAL SPECIALIST LLC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL SPECIALIST LLC
Other - Org Name:NW BRAIN AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-585-2400
Mailing Address - Street 1:2115 NE WYATT CT
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7678
Mailing Address - Country:US
Mailing Address - Phone:541-585-2400
Mailing Address - Fax:541-585-2407
Practice Address - Street 1:2115 NE WYATT CT
Practice Address - Street 2:SUITE #201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7678
Practice Address - Country:US
Practice Address - Phone:541-585-2400
Practice Address - Fax:541-585-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR121087Medicare PIN