Healthcare Provider Details

I. General information

NPI: 1235210550
Provider Name (Legal Business Name): NORTHWEST REGIONAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 HARLAN BURNTWOODS RD SUITE 100
BLODGETT OR
97326-9720
US

IV. Provider business mailing address

PO BOX 4774
PORTLAND OR
97208-4774
US

V. Phone/Fax

Practice location:
  • Phone: 541-438-4104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier228877
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. STEVE JORGENSEN
Title or Position: CEO
Credential:
Phone: 541-438-4104