Provider Demographics
NPI:1215983200
Name:NORTHWEST ACUTE CARE SPECIALISTS PC
Entity type:Organization
Organization Name:NORTHWEST ACUTE CARE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VISSERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-464-9034
Mailing Address - Street 1:PO BOX 11810
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1810
Mailing Address - Country:US
Mailing Address - Phone:562-809-3540
Mailing Address - Fax:562-468-0504
Practice Address - Street 1:825 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 1155
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2135
Practice Address - Country:US
Practice Address - Phone:503-464-9034
Practice Address - Fax:503-464-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168662Medicaid
OR241914Medicaid
WA7088305Medicaid
OR168662Medicaid
WA7088305Medicaid