Healthcare Provider Details

I. General information

NPI: 1609328301
Provider Name (Legal Business Name): NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HWY 224 SUITE 100
ESTACADA OR
97023-7022
US

IV. Provider business mailing address

1000 3RD ST
TILLAMOOK OR
97141-3430
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number141177
License Number StateOR

VIII. Authorized Official

Name: MR. MICAH SMITH
Title or Position: CFO/DIRECTOR OF FINANCE
Credential:
Phone: 503-815-2263