Organization
NORTHWEST PRIMARY CARE GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WHITBECK (ADMINISTRATOR)
(503) 659-4777
Entity
Organization
Contact information
Practice address
6327 SE MILWAUKIE AVE, PORTLAND, OR 97202-5418
(503) 659-4988
(503) 353-1293
Mailing address
PO BOX 22075, MILWAUKIE, OR 97269-2075
(503) 659-4777
(503) 652-5223
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274689
—
OR
01
—
38D1059196
CLIA
OR
01
—
CE8055
RAILROAD GROUP PTAN
OR
Enumeration date
10/12/2006
Last updated
06/03/2020
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