Provider Demographics
NPI:1730118803
Name:NORTHWEST SURGICAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NORTHWEST SURGICAL SPECIALISTS, P.C.
Other - Org Name:REBOUND ORTHOPEDICS & NEUROSURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-254-6161
Mailing Address - Street 1:200 NE MOTHER JOSEPH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3299
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1139
Practice Address - Street 1:1 N CENTER COURT ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2104
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231808Medicaid
WA7883200Medicaid
WACO3343Medicare PIN
ORCK7102Medicare PIN
WA7883200Medicaid
ORR106658Medicare PIN