1023530094 NPI number — NORTHWEST SURGICAL DEVELOPMENT

Table of content: (NPI 1023530094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023530094 NPI number — NORTHWEST SURGICAL DEVELOPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST SURGICAL DEVELOPMENT
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:
Provider Other Organization Name Type Code:
6
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:
1023530094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 ENTERPRISE STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-600-9941
Provider Business Mailing Address Fax Number:
949-600-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17885 NW EVERGREEN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97006-7494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-246-5291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GILLETT
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE SPECIALIST
Authorized Official Telephone Number:
949-600-9941

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  16741689 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com