Provider Demographics
NPI:1699146159
Name:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Entity type:Organization
Organization Name:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-815-2263
Mailing Address - Street 1:1000 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3430
Mailing Address - Country:US
Mailing Address - Phone:503-842-4444
Mailing Address - Fax:
Practice Address - Street 1:5995 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9689
Practice Address - Country:US
Practice Address - Phone:503-842-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-09
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR141177282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access