Provider Demographics
NPI:1386168029
Name:NORTHWEST MINIMALLY INVASIVE SURGERY, LLC
Entity type:Organization
Organization Name:NORTHWEST MINIMALLY INVASIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TSENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-914-0024
Mailing Address - Street 1:1040 NW 22ND AVE STE 470
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3062
Mailing Address - Country:US
Mailing Address - Phone:503-914-0024
Mailing Address - Fax:503-914-0025
Practice Address - Street 1:1040 NW 22ND AVE STE 470
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3062
Practice Address - Country:US
Practice Address - Phone:503-914-0024
Practice Address - Fax:503-914-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty