NORTHWEST EXTREMITY SPECIALISTS (NPI# 1205207073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205207073 |
| Entity Type | Organization |
| Organization Name | NORTHWEST EXTREMITY SPECIALISTS |
| Practice Address |
831 Nw Council Dr Ste 203 Gresham OR 97030-3723 |
| Mailing Address |
6542 Se Lake Rd Ste 106 Milwaukie OR 97222-2245 |
| Practice Telephone | 5036676600 |
| Practice Fax Number | 5036676608 |
| Mailing Telephone | 5036676600 |
| Mailing Fax Number | 5036676608 |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |
| Authorized Official Name | HEIDI T MCCAMMON (ADMINISTRATOR) |
| Authorized Official Telephone | 5036676600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 332BC3200X | OR | Suppliers |
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 335E00000X | OR | Suppliers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | NORTHWEST EXTREMITY SPECIALISTS, LLC | 9900 Sw Hall Blvd Ste 100, Tigard, OR 97223 |
| Street Address |
831 NW COUNCIL DR STE 203 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831739127 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 24076 Se Stark St Ste 320, Gresham, OR 97030-3386 | 2020-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811500705 | Synergy Medical Systems, LLC | Prosthetic/Orthotic Supplier | 19365 Sw 65th Ave Ste 210, Tualatin, OR 97062-9196 | 2020-08-28 |
| 1881007607 | Shannon Levin | Prosthetic/Orthotic Supplier | 441 Union St Ne, Salem, OR 97301-2458 | 2014-06-09 |
| 1174892640 | Cognitive Harmonics, Inc | Prosthetic/Orthotic Supplier | 2104 Hill Way, Medford, OR 97504-6208 | 2011-12-29 |
| 1841581717 | Pacific Footwear Company Inc | Prosthetic/Orthotic Supplier | 1150 Knutson Ave, Suite 12, Medford, OR 97504-3100 | 2011-04-27 |
| 1417257742 | A Step Forward LLC | Prosthetic/Orthotic Supplier | 744 Hawthorne Ave Ne, Salem, OR 97301-4675 | 2010-11-03 |
| 1467783761 | Elliott Pedorthic Care LLC | Prosthetic/Orthotic Supplier | 85084 Kensington Dr, Pleasant Hill, OR 97455-9621 | 2010-01-26 |
| 1780836049 | Angel Hair Foundation Inc | Prosthetic/Orthotic Supplier | 2783 Suncrest Ave, Eugene, OR 97405-5923 | 2008-10-17 |
| 1295986065 | Mirage Hair Systems, Inc. | Prosthetic/Orthotic Supplier | Suite 210 Oakway Ctr, Suite 210, Eugene, OR 97401-5618 | 2008-10-09 |
| 1457517138 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 16679 Boones Ferry Rd Ste 215, Lake Oswego, OR 97035-4368 | 2008-08-01 |
| 1518148105 | Paradox Walkfit Inc. | Prosthetic/Orthotic Supplier | 15532 Sw Pacific Hwy, Suite C1a, Tigard, OR 97224-3598 | 2007-11-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on NORTHWEST EXTREMITY SPECIALISTS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.