Provider Demographics
NPI:1568864171
Name:THOMAS P MCWEENEY MD PC
Entity type:Organization
Organization Name:THOMAS P MCWEENEY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:503-506-8384
Mailing Address - Street 1:19255 SW 65TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9717
Mailing Address - Country:US
Mailing Address - Phone:503-506-8384
Mailing Address - Fax:503-506-8364
Practice Address - Street 1:19255 SW 65TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9717
Practice Address - Country:US
Practice Address - Phone:503-506-8384
Practice Address - Fax:503-506-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty