Provider Demographics
NPI:1952087678
Name:NORTHWEST EXTREMITY SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHWEST EXTREMITY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERIDIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-577-2964
Mailing Address - Street 1:6485 SW BORLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6485 SW BORLAND RD STE A
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-352-1313
Practice Address - Fax:503-352-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty