Provider Demographics
NPI:1609328301
Name:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN & CLINIC SERV EXECUTIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEUFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-815-2414
Mailing Address - Street 1:1000 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SE HWY 224
Practice Address - Street 2:SUITE 100
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-7022
Practice Address - Country:US
Practice Address - Phone:503-842-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
OR141177282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access