MEDICARE: NORTHWEST WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205703287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	149 CLEAR CREEK DR UNIT 108
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1882
Country	:	US
Telephone Number	:	541-482-8333
Fax Number	:	541-482-8398

Provider Business Practice Location Address
First Line	:	149 CLEAR CREEK DR UNIT 108
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1882
Country	:	US
Telephone Number	:	541-482-8333
Fax Number	:	541-482-8398

Authorized Official
Title or Position	:	AUTHORIZED OFFICAL
Name	:	DEBORAH GORDON
Credential	:	MD
Telephone Number	:	541-482-8333

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	04/07/2026

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Directions to “NORTHWEST WELLNESS CENTER LLC ” Practice Location

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