Provider Demographics
NPI:1548368012
Name:ORTHOPEDICS NORTHWEST PC
Entity type:Organization
Organization Name:ORTHOPEDICS NORTHWEST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-639-6002
Mailing Address - Street 1:15755 SW SEQUOIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7166
Mailing Address - Country:US
Mailing Address - Phone:503-639-6002
Mailing Address - Fax:503-620-4332
Practice Address - Street 1:15755 SW SEQUOIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7166
Practice Address - Country:US
Practice Address - Phone:503-639-6002
Practice Address - Fax:503-639-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138119Medicaid
OR106488Medicare PIN
OR4121980001Medicare NSC
OR138119Medicaid