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Organization
NORTHWEST GERIACTRICS
Active
Organization
NORTHWEST GERIACTRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK L PHILLIPS MBA/MHA (PRESIDENT)
(435) 862-6143
Entity
Organization
Contact information
Practice address
10365 SE SUNNYSIDE RD STE 340, CLACKAMAS, OR 97015-5751
(143) 586-2614
Mailing address
206 N 2100 W STE 202, SALT LAKE CITY, UT 84116-4741
(435) 862-6143
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
—
NULL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
Other
Enumeration date
05/28/2020
Last updated
05/28/2020
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