NORTHWEST EXTREMITY SPECIALISTS LLC NPI 1124603055

NPI Information

NPI: 1124603055
Provider Name: NORTHWEST EXTREMITY SPECIALISTS LLC
Classification: Clinic/Center - 261QP1100X
Entity Type: Organization

Specialization: Podiatric

Address:
12658 SE STARK ST BLDG H
PORTLAND, OR
ZIP 97233
Phone: (503) 221-1581
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NORTHWEST EXTREMITY SPECIALISTS LLC is a podiatric clinic center in Portland, OR. NORTHWEST EXTREMITY SPECIALISTS LLC NPI is 1124603055. The provider is registered as an organization entity type.

The provider's business location address is:

12658 SE STARK ST BLDG H
PORTLAND, OR
ZIP 97233-058
Phone: (503) 221-1581
Fax: (503) 221-1582

The provider's authorized official is Thomas Charles Melillo .
The authorized official title is Owner and has the following contact phone number (503) 245-2420.

The enumeration date for this NPI number is 3/11/2021 and was last updated on 3/11/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP1100X	Clinic/Center	Podiatric			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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