Justin A Tidwell (NPI# 1710908892, PAC ID# 0042244725) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
Nation Provider ID (NPI) | 1710908892 |
PAC ID by PECOS | 0042244725 |
Professional Enrollment ID | I20070206000698 |
Full Name | Justin A Tidwell |
Organization Legal Name | LEGACY CLINICS LLC |
Address |
24800 Se Stark St Gresham OR 97030-3378 |
Phone Number | 5034138988 |
Gender | M |
Credential | DPM |
Graduation Year | 2003 |
Primary Specialty | PODIATRY |
Group Practice PAC ID | 0244144004 |
Number of Group Practice Members | 466 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
380007 | LEGACY EMANUEL MEDICAL CENTER |
380017 | LEGACY GOOD SAMARITAN MEDICAL CENTER |
Address | Phone | Organization |
---|---|---|
24800 Se Stark St, Gresham, OR 97030-3378 | 5034138988 | LEGACY CLINICS LLC |
1015 Nw 22nd Ave, Portland, OR 97210-3025 | 5034137711 | LEGACY CLINICS LLC |
1015 Nw22nd Ave, Suite 34, Portland, OR 97210-3025 | 5034136376 | LEGACY CLINICS LLC |
1130 Nw 22nd Ave, Portland, OR 97210-2934 | LEGACY CLINICS LLC | |
1130 Nw 22nd Ave, Suite 220, Portland, OR 97210-2969 | 5034138988 | LEGACY CLINICS LLC |
2801 N Gantenbein Ave, Portland, OR 97227-1623 | LEGACY CLINICS LLC | |
501 N Graham St, Suite 415, Portland, OR 97227-2006 | 5034133580 | LEGACY CLINICS LLC |
2101 Ne 139th St, Suite 260, Vancouver, WA 98686-2311 | 3604872870 | LEGACY SALMON CREEK HOSPITAL |
Organization Legal Name | LEGACY CLINICS LLC |
Physicians | 495 |
Name | Specialty | Organization | Address |
---|---|---|---|
Elana Underwood Scharff | Nurse Practitioner | Legacy Clinics LLC | 25050 Se Stark St, Suite 265, Gresham, OR 97030-3388 |
Jonathan Parker | Physician Assistant | Legacy Clinics LLC | 2870 Sw Cedar Hills Blvd, Beaverton, OR 97005-1354 |
Patricia Funk | Internal Medicine | Legacy Clinics LLC | 19300 Sw 65th Ave, Meridian Park Hosp, Portland, OR 97062-7706 |
Eric Austin Jordan Nash | Nurse Practitioner | Legacy Clinics LLC | 3425 Se 192nd Ave, Suite 106, Vancouver, WA 98683-1440 |
Amany Bashir | Family Medicine | Legacy Clinics LLC | 8329 Sw Bverton Hills Hwy, Portland, OR 97225-2215 |
Gayle L Shears | Physician Assistant | Legacy Clinics LLC | 3 Monroe Pkwy, Suite X, Lake Oswego, OR 97035-8875 |
Theresa Rene Jones | Physician Assistant | Legacy Clinics LLC | 22262 Ne Glisan St, Gresham, OR 97030-8553 |
Sean Robert Schulz | Family Medicine | Legacy Clinics LLC | 36860 Industrial Way, Sandy, OR 97055-7371 |
Lucas J Martin | Physician Assistant | Legacy Clinics LLC | 305 Se Chkalov Dr, Suite 170, Vancouver, WA 98683-5292 |
Aaron W Spaugy | Internal Medicine | Legacy Clinics LLC | 1015 Nw22nd Ave, Suite 34, Portland, OR 97210-3025 |
Street Address |
24800 SE STARK ST |
City | GRESHAM |
State | OR |
Zip | 97030-3378 |
Name | Specialty | Organization | Address |
---|---|---|---|
Emmanuel Tavan | Pulmonary Disease | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Kathrin R Meyers | Internal Medicine | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Elizabeth T Kutella | Diagnostic Radiology | Tualatin Imaging PC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Elliot Joo | Gastroenterology | Portland Adventist Medical Center | 24800 Se Stark St, Gresham, OR 97030-3378 |
Michelle Dwulit | Internal Medicine | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Andrew Y Kee | Radiation Oncology | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Sarah A Walter | Pathology | Cascade Pathology Services Corp | 24800 Se Stark St, Gresham, OR 97030-3378 |
Brian R Mahon | Diagnostic Radiology | Tualatin Imaging PC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Ange Mong Ly | Internal Medicine | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Scott D Sonek | Nurse Practitioner | Legacy Clinics LLC | 24800 Se Stark St, Gresham, OR 97030-3378 |
Find all physicians in the same address |
Name | Specialty | Organization | Address |
---|---|---|---|
Anne T Daly | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
David A Pierce | Family Medicine | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Agnes White | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Jaclyn Jones | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Elizabeth Claire Yiu | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Emma Moore | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Mary Jepson | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
Amanda Cort | Nurse Practitioner | Multnomah County | 2020 Se 182nd Ave, Rockwood Health Center, Gresham, OR 97030 |
John L Strauss | Chiropractic | 620 Se 223rd Ave, Gresham, OR 97030-2510 | |
Mark A George | Optometry | 22640 Se Stark St, Gresham, OR 97030-2684 | |
Find all physicians in zip 97030 |
City | GRESHAM |
Zip Code | 97030 |
Specialty | PODIATRY |
City + Specialty | GRESHAM + PODIATRY |
Please comment or provide details below to improve the information on Justin A Tidwell.
Data Provider | Centers for Medicare & Medicaid Services (CMS) |
Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.