Provider Demographics
NPI:1841040292
Name:NORTHWEST SPINE SURGERY LLC
Entity type:Organization
Organization Name:NORTHWEST SPINE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NELSON FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-277-0559
Mailing Address - Street 1:10000 SE MAIN ST STE 360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2474
Mailing Address - Country:US
Mailing Address - Phone:503-253-4000
Mailing Address - Fax:503-253-4002
Practice Address - Street 1:10,000 SE MAIN ST ST 360
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216
Practice Address - Country:US
Practice Address - Phone:503-253-4000
Practice Address - Fax:503-253-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty