Provider Demographics
NPI:1982861902
Name:NORTHWEST MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TOAN
Authorized Official - Last Name:TVINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-675-7495
Mailing Address - Street 1:4035 SW MERCANTILE DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-675-7495
Mailing Address - Fax:503-675-7496
Practice Address - Street 1:4035 SW MERCANTILE DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-675-7495
Practice Address - Fax:503-675-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34884Medicare UPIN
R108744Medicare PIN