Provider Demographics
NPI:1760674071
Name:GERIATRIC PSYCHIATRY ASSOCIATES NORTHWEST, P.C.
Entity Type:Organization
Organization Name:GERIATRIC PSYCHIATRY ASSOCIATES NORTHWEST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-258-9714
Mailing Address - Street 1:1231 NE MLK JR BLVD
Mailing Address - Street 2:#611
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2073
Mailing Address - Country:US
Mailing Address - Phone:503-258-9714
Mailing Address - Fax:503-254-4840
Practice Address - Street 1:1231 NE MLK JR BLVD
Practice Address - Street 2:#611
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2073
Practice Address - Country:US
Practice Address - Phone:503-258-9714
Practice Address - Fax:503-254-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD118912084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty