Provider Demographics
NPI:1619089083
Name:NORTHWEST VEIN SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NORTHWEST VEIN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-352-0427
Mailing Address - Street 1:515 NW SALTZMAN RD
Mailing Address - Street 2:PMB 916
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6098
Mailing Address - Country:US
Mailing Address - Phone:503-352-0427
Mailing Address - Fax:
Practice Address - Street 1:12400 NW CORNELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5693
Practice Address - Country:US
Practice Address - Phone:503-352-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty