Healthcare Provider Details

I. General information

NPI: 1134955545
Provider Name (Legal Business Name): NORTHWEST PRIMARY CARE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12117 SE STEVENS ROAD
HAPPY VALLEY OR
97086
US

IV. Provider business mailing address

PO BOX 22075
MILWAUKIE OR
97269-2075
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax:
Mailing address:
  • Phone: 503-659-4988
  • Fax: 833-428-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABBY NACHAND
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 503-659-4777