Provider Demographics
NPI:1952477820
Name:NORTHWEST FOOT & ANKLE
Entity Type:Organization
Organization Name:NORTHWEST FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-243-2699
Mailing Address - Street 1:725 NW 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1301
Mailing Address - Country:US
Mailing Address - Phone:503-243-2699
Mailing Address - Fax:503-243-2698
Practice Address - Street 1:725 NW 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1301
Practice Address - Country:US
Practice Address - Phone:503-243-2699
Practice Address - Fax:503-243-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00317213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR208339OtherDSHS (MEDICAID)
ORMC5942OtherREGENCE RIDER
OR480027978OtherRAILROAD MEDICARE
OR1101682Medicaid
OR1101682Medicaid
OR1101682Medicaid
OR1296200001Medicare NSC
ORBM5493628OtherDEA