NORTHWEST EXTREMITY SPECIALISTS LLC
Clinic/Center (Podiatric)

Address: 12658 Se Stark St Bldg H, Portland, OR 97233-1058

NORTHWEST EXTREMITY SPECIALISTS LLC (NPI# 1124603055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124603055
Entity Type Organization
Organization Name NORTHWEST EXTREMITY SPECIALISTS LLC
Practice Address 12658 Se Stark St Bldg H
Portland
OR 97233-1058
Practice Telephone 5032211581
Practice Fax Number 5032211582
Mailing Address 9115 Sw Oleson Rd Ste 205
Tigard
OR 97223-6877
Mailing Telephone 5032452420
Certification Date 2021-03-11
Enumeration Date 2021-03-11
Last Update Date 2021-03-11
Authorized Official Telephone 5032452420
Authorized Official Credential DPM
Is Organization Subpart Y
Parent Organization Name NORTHWEST EXTREMITY SPECIALISTS LLC

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Grouping
Y 261QP1100X Clinic/Center
Specialization: Podiatric
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
NES Gresham Other Name

Other providers with the same name

NPI Name Taxonomy Address Enumeration
1386229219 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 10690 Ne Cornell Rd Ste 212, Hillsboro, OR 97124-9224 2021-03-11
1669057592 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 1000 N Providence Dr Ste 320, Newberg, OR 97132-7582 2021-03-11
1750966792 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 18040 Sw Lower Boones Ferry Rd Ste 207, Tigard, OR 97224-7259 2021-03-11
1477138303 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 16770 Sw Edy Rd Ste 318, Sherwood, OR 97140-9678 2021-03-11
1659956589 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 2222 Nw Lovejoy St Ste 510, Portland, OR 97210-5103 2021-03-11
1912582842 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 5499 Amy St, West Linn, OR 97068-3320 2021-03-11
1922683366 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 201 N Washington St, Newberg, OR 97132-2727 2021-03-17
1760067698 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 5050 Ne Hoyt St Ste 411, Portland, OR 97213-2983 2021-03-11
1841875770 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 6542 Se Lake Rd Ste 102, Milwaukie, OR 97222-2245 2021-03-11
1306421219 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 12400 Nw Cornell Rd Ste 201, Portland, OR 97229-5689 2021-03-11
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Office Location

Street Address 12658 SE STARK ST BLDG H
City PORTLAND
State OR
Zip Code 97233-1058

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1871140350 Anthony Douglas Dejesus Counselor - Addiction (Substance Use Disorder) 12662 Se Stark St, Portland, OR 97233-1058 2019-08-20
1003307653 Rescue Life Senior Care Agency In Home Supportive Care 12640 Se Stark St, Portland, OR 97233-1058 2018-05-18
1457793200 Johneen Manno Counselor - Mental Health 12672 Se Stark St Bldg A, Portland, OR 97233-1058 2013-07-22
1366743635 Kaitlyn Elizabeth Starr · Kaitlyn Elizabeth Weitz Occupational Therapist 12650 Se Stark St Bldg I, Portland, OR 97233-1058 2010-11-03
1053621912 Jacob Russell Moss Social Worker 12636 Se Stark St, Plaza 125, Bldg J, Portland, OR 97233-1058 2010-10-13
1336474543 Christa Lee Piazza Physical Therapist 12672 Se Stark St, Pl 125 Bldg A, Portland, OR 97233-1058 2009-10-05
1093993453 Lyndon G Johansen Dpm PC Clinic/Center - Podiatric 12658 Se Stark St, Portland, OR 97233-1058 2008-02-07
1861673261 Kathleen Murray Social Worker - Clinical 12606 Se Stark St, Bldg M., Portland, OR 97233-1058 2007-11-14
1487849766 Jonathan David Rabon Counselor - Mental Health 12636 Se Stark St Plaza 125 Bldg J, Portland, OR 97233-1058 2007-09-11
1245446103 Amanda Edwards Keegan Physical Therapist 12616 Se Stark St Bldg L, Portland, OR 97233-1058 2007-05-15
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Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1205448164 Moore Therapy Services, LLC Behavioral Analyst 2053 Se 181st Ave, Portland, OR 97233 2020-08-20
1427563733 Central City Concern Inc · Hansen Shelter Clinic Clinic/Center - Federally Qualified Health Center (FQHC) 1415 Se 122nd Ave, Portland, OR 97233 2017-12-08
1013570548 Christa R Andreasen Registered Nurse 12360 E Burnside St, Portland, OR 97233-1042 2019-04-19
1033622386 David Anthony Alarcon Speech-Language Pathologist 12441 Se Stark St, Portland, OR 97233-1053 2017-11-08
1134732100 Jacob R Kaufman Dentist 12596 Se Stark St Bldg N, Portland, OR 97233-1056 2020-08-28
1326649500 African Youth and Community Organization · Ayco Community Health Worker 1390 Se 122nd Ave Ste Ue, Portland, OR 97233-1203 2020-11-04
1255983029 Opticare Optometry Optometrist 1370 Se 122nd Ave, Portland, OR 97233-1203 2019-07-11
1336646421 Nwmc Chiropractic Care LLC Chiropractor 1350 Se 122nd Ave, Portland, OR 97233-1203 2018-04-06
1275193260 Anna Khval Counselor - Addiction (Substance Use Disorder) 1500 Se 122nd Ave, Portland, OR 97233-1207 2019-06-20
1750994984 Mercy Home Care Agency LLC In Home Supportive Care 2057 Se 122nd Ave, Portland, OR 97233-1305 2020-08-27
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Taxonomy Information

Taxonomy Code 261QP1100X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Podiatric

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1659952216 Downtown Foot Clinic, LLC Clinic/Center - Podiatric 610 Sw Alder St Ste 506, Portland, OR 97205-3606 2021-04-15
1659956589 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 2222 Nw Lovejoy St Ste 510, Portland, OR 97210-5103 2021-03-11
1093993453 Lyndon G Johansen Dpm PC Clinic/Center - Podiatric 12658 Se Stark St, Portland, OR 97233-1058 2008-02-07
1760067698 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 5050 Ne Hoyt St Ste 411, Portland, OR 97213-2983 2021-03-11
1306421219 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 12400 Nw Cornell Rd Ste 201, Portland, OR 97229-5689 2021-03-11
1851557607 Ankle and Foot Clinic of Oregon Clinic/Center - Podiatric 5528 Se Powell Blvd, Portland, OR 97206-2956 2008-07-31

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1659952216 Downtown Foot Clinic, LLC Clinic/Center - Podiatric 610 Sw Alder St Ste 506, Portland, OR 97205-3606 2021-04-15
1386229219 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 10690 Ne Cornell Rd Ste 212, Hillsboro, OR 97124-9224 2021-03-11
1669057592 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 1000 N Providence Dr Ste 320, Newberg, OR 97132-7582 2021-03-11
1750966792 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 18040 Sw Lower Boones Ferry Rd Ste 207, Tigard, OR 97224-7259 2021-03-11
1477138303 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 16770 Sw Edy Rd Ste 318, Sherwood, OR 97140-9678 2021-03-11
1659956589 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 2222 Nw Lovejoy St Ste 510, Portland, OR 97210-5103 2021-03-11
1912582842 Northwest Extremity Specialists LLC Clinic/Center - Podiatric 5499 Amy St, West Linn, OR 97068-3320 2021-03-11

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City PORTLAND
Zip Code 97233

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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