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NPI Code Detail

MEDICARE: NORTHWEST IV, LLC

MEDICARE: NORTHWEST IV, LLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2207L00000XAnesthesiology Physician
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1801564141
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST IV, LLC
Provider Business Mailing Address
First Line : 6400 SE LAKE RD STE 155
Second Line :
City : PORTLAND
State : OR
Zip : 97222-2137
Country : US
Telephone Number : 971-358-9292
Fax Number : 503-917-4971
Provider Business Practice Location Address
First Line : 8285 W ARBY AVE STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2236
Country : US
Telephone Number : 971-358-9292
Fax Number :
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : JOHN PERRY
Credential :
Telephone Number : 503-447-3285
Provider Enumeration Date : 09/01/2021
Last Update Date : 02/05/2026

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