Provider Demographics
NPI:1861438327
Name:NORTHWEST VASCULAR CONSULTANTS INC
Entity type:Organization
Organization Name:NORTHWEST VASCULAR CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-9565
Mailing Address - Street 1:9701 SW BARNES RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-292-9565
Mailing Address - Fax:503-292-9478
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:SUITE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-292-9565
Practice Address - Fax:503-292-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCJQZMedicare ID - Type Unspecified