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General NPI Number Information
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NPI Number | 1750748901
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Entity Type | Organization
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Legal Business Name | NORTHWEST RENAL CLINIC, INC.
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 730 SE OAK ST SUITE I
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City | HILLSBORO
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State | OR
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Zip | 97123-4245
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Country | US
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Telephone | 503-430-0497
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Fax | 503-747-5985
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Provider Business Mailing Address
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Address Line | 1130 NW 22ND AVE SUITE 640
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City | PORTLAND
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State | OR
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Zip | 97210-2900
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Country | US
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Telephone | 503-229-7976
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Fax | 503-274-4867
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Authorized Official
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Title or Position | MD
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Name | CLAYTON M SMILEY
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Credential |
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Telephone | 503-229-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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