MEDICARE: NORTHWEST PRIMARY CARE GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	133V00000X	Registered Dietitian
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38D0888269	OTHER	OR	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	CE8055	OTHER	OR	RAILROAD GROUP PTAN

General Provider Information

NPI Number	:	1043230972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PRIMARY CARE GROUP PC

Provider Business Mailing Address
First Line	:	PO BOX 22075
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97269-2075
Country	:	US
Telephone Number	:	503-659-4777
Fax Number	:	503-652-5223

Provider Business Practice Location Address
First Line	:	16144 SE HAPPY VALLEY TOWN CENTER DR STE 101
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-4257
Country	:	US
Telephone Number	:	503-659-4988
Fax Number	:	503-698-4018

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MICHAEL WHITBECK
Credential	:
Telephone Number	:	503-659-4777

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	06/03/2020

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