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NPI Code Detail

MEDICARE: NORTHWEST PRIMARY CARE GROUP, PC

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 License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1700122058
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 : 1511 DIVISION ST STE 101
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1589
Country : US
Telephone Number : 503-659-4988
Fax Number : 503-353-1234
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. MICHAEL WHITBECK
Credential :
Telephone Number : 503-659-4777
Provider Enumeration Date : 12/13/2012
Last Update Date : 06/11/2020

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