Provider Demographics
NPI:1891933123
Name:NORTHWEST MEDICAL STAFFING, LLC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-638-4303
Mailing Address - Street 1:5319 SW WESTGATE DR
Mailing Address - Street 2:241
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2411
Mailing Address - Country:US
Mailing Address - Phone:503-297-7223
Mailing Address - Fax:503-297-7603
Practice Address - Street 1:21600 SW STAFFORD RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8726
Practice Address - Country:US
Practice Address - Phone:503-638-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17458207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty