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General NPI Number Information
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NPI Number | 1114396199
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Entity Type | Organization
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Legal Business Name | NORTHWEST MEDICAL HOMES, LLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 1800 CENTENNIAL BLVD
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City | SPRINGFIELD
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State | OR
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Zip | 97477-4385
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Country | US
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Telephone | 541-747-4300
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Fax | 541-284-5534
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Provider Business Mailing Address
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Address Line | 2280 MARCOLA RD
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City | SPRINGFIELD
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State | OR
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Zip | 97477-2594
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Country | US
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Telephone | 541-747-4300
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Fax | 541-284-5534
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Authorized Official
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Title or Position | PARTNER/ OFFICER
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Name | DR. MARK STANLEY MEYERS
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Credential | M.D.
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Telephone | 541-747-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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