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NPI Code Detail

MEDICARE: PACIFIC NORTHWEST RENAL SERVICES, L.L.C.

MEDICARE: PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1083726988
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Provider Business Mailing Address
First Line : 2701 NW VAUGHN ST STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97210-5379
Country : US
Telephone Number : 503-205-0320
Fax Number : 503-205-0641
Provider Business Practice Location Address
First Line : 2701 NW VAUGHN ST STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97210-5379
Country : US
Telephone Number : 503-205-0320
Fax Number : 503-205-0641
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 08/31/2006
Last Update Date : 08/04/2021

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