# NORTHWEST EXTREMITY SPECIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHWEST EXTREMITY SPECIALISTS LLC
- **Other names:** NES Orthopedics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629774179
- **Legal business name:** NORTHWEST EXTREMITY SPECIALISTS LLC
- **Authorized official:** SHEADAWN FOGERSON (AREA OPERATIONS DIRECTOR)
- **Authorized official phone:** (503) 352-1313

## Contact information

- **Practice address:** 9445 SW LOCUST ST, TIGARD, OR 97223-6634
- **Practice address phone:** (503) 245-2420
- **Mailing address:** 9115 SW OLESON RD STE 205, PORTLAND, OR 97223-6877
- **Mailing address phone:** (503) 245-2420
- **Mailing address fax:** (503) 245-2445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/06/2023
- **Last updated:** 08/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1174973242 | ORTHOPEDIC | CA |