Provider Demographics
NPI:1124445903
Name:NW MEDICAL CENTER
Entity type:Organization
Organization Name:NW MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARANCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-347-2581
Mailing Address - Street 1:10249 NE CLACKAMAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3915
Mailing Address - Country:US
Mailing Address - Phone:503-206-6078
Mailing Address - Fax:
Practice Address - Street 1:10249 NE CLACKAMAS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3915
Practice Address - Country:US
Practice Address - Phone:503-206-6078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty