1730118803 NPI number — NORTHWEST SURGICAL SPECIALISTS, P.C.

Table of content: (NPI 1730118803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730118803 NPI number — NORTHWEST SURGICAL SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST SURGICAL SPECIALISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REBOUND ORTHOPEDICS & NEUROSURGICAL SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730118803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-3299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-6161
Provider Business Mailing Address Fax Number:
360-449-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 N CENTER COURT ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-6161
Provider Business Practice Location Address Fax Number:
360-449-1146
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRARY
Authorized Official First Name:
JAY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-254-6161

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 231808 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7883200 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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