# NORTHWEST GERIACTRICS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639793367
- **Authorized official:** MARK L PHILLIPS MBA/MHA (PRESIDENT)
- **Authorized official phone:** (435) 862-6143

## Contact information

- **Practice address:** 10365 SE SUNNYSIDE RD STE 340, CLACKAMAS, OR 97015-5751
- **Practice address phone:** (143) 586-2614
- **Mailing address:** 206 N 2100 W STE 202, SALT LAKE CITY, UT 84116-4741
- **Mailing address phone:** (435) 862-6143

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/28/2020
- **Last updated:** 05/28/2020