Provider Demographics
NPI:1790777258
Name:NORTHWEST CARDIOVASCULAR INSTITUTE, LLP
Entity Type:Organization
Organization Name:NORTHWEST CARDIOVASCULAR INSTITUTE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-229-7554
Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:#606
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-229-7554
Mailing Address - Fax:503-274-5400
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:#606
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-229-7554
Practice Address - Fax:503-274-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR428335207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127137Medicaid
OR0621650OtherBLUE CROSS
WA7127137Medicaid