Provider Demographics
NPI:1396378717
Name:NORTHWEST RENAL CLINIC, INC.
Entity type:Organization
Organization Name:NORTHWEST RENAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-229-7976
Mailing Address - Street 1:925 COMMERCIAL ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4172
Mailing Address - Country:US
Mailing Address - Phone:503-967-6670
Mailing Address - Fax:503-585-2185
Practice Address - Street 1:925 COMMERCIAL ST SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4172
Practice Address - Country:US
Practice Address - Phone:503-967-6670
Practice Address - Fax:503-585-2185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST RENAL CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty