Healthcare Provider Details

I. General information

NPI: 1023032372
Provider Name (Legal Business Name): NORTHWEST PRIMARY CARE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16144 SE HAPPY VALLEY TOWN CENTER DR STE 101
HAPPY VALLEY OR
97086-4257
US

IV. Provider business mailing address

PO BOX 22075
MILWAUKIE OR
97269-2075
US

V. Phone/Fax

Practice location:
  • Phone: 503-353-1272
  • Fax: 503-654-4815
Mailing address:
  • Phone: 503-659-4777
  • Fax: 503-652-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL WHITBECK
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-659-4777