Provider Demographics
NPI:1700927928
Name:NORTHWEST ENT AND ALLERGY CARE INC
Entity Type:Organization
Organization Name:NORTHWEST ENT AND ALLERGY CARE INC
Other - Org Name:NORTHWEST ENT & ALLERGY CARE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-281-3130
Mailing Address - Street 1:10330 SE 32ND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6587
Mailing Address - Country:US
Mailing Address - Phone:503-513-8693
Mailing Address - Fax:
Practice Address - Street 1:10330 SE 32ND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6587
Practice Address - Country:US
Practice Address - Phone:503-513-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25584207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006456Medicaid
OR241602Medicaid
OR241602Medicaid
R137515Medicare PIN
I09641Medicare UPIN