Provider Demographics
NPI:1831802776
Name:NW MEDICAL WEIGHT MANAGEMENT LLC
Entity type:Organization
Organization Name:NW MEDICAL WEIGHT MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PURKEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-510-0630
Mailing Address - Street 1:535 CASTLE GLEN LN N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7497
Mailing Address - Country:US
Mailing Address - Phone:503-510-0630
Mailing Address - Fax:
Practice Address - Street 1:3675 RIVER RD N STE 103
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5994
Practice Address - Country:US
Practice Address - Phone:503-510-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty