1124234703 NPI number — NORTHWEST FAMILY MEDICINE L.L.C.

Table of content: (NPI 1124234703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124234703 NPI number — NORTHWEST FAMILY MEDICINE L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST FAMILY MEDICINE L.L.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:
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:
1124234703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 WELCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97381-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-873-6987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 WELCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97381-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-873-6987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-873-6987

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  MD17287 , 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)

  • Identifier: 1205807112 . This is a "DR ERIC NORTH NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1336110469 . This is a "NPI DR PHOENIX NORTH" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R103594 . This is a "GROUP NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1376511998 . This is a "DR TIM PETERS NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1427127057 . This is a "DR SARAH PETERS NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1124234703 . This is a "NW FAMILY MED NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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