Healthcare Provider Details

I. General information

NPI: 1114396199
Provider Name (Legal Business Name): NORTHWEST MEDICAL HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CENTENNIAL BLVD
SPRINGFIELD OR
97477-4385
US

IV. Provider business mailing address

2280 MARCOLA RD
SPRINGFIELD OR
97477-2594
US

V. Phone/Fax

Practice location:
  • Phone: 541-747-4300
  • Fax: 541-284-5534
Mailing address:
  • Phone: 541-747-4300
  • Fax: 541-284-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK STANLEY MEYERS
Title or Position: PARTNER/ OFFICER
Credential: M.D.
Phone: 541-747-4300