Organization
NORTHWEST PRIMARY CARE GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WHITBECK (ADMINISTRATOR)
(503) 659-4777
Entity
Organization
Contact information
Practice address
12300 SE MALLARD WAY, SUITE 160, MILWAUKIE, OR 97222-4616
(503) 659-4777
(503) 652-5223
Mailing address
PO BOX 22075, MILWAUKIE, OR 97269-2075
(503) 659-4777
(503) 652-5223
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022990
—
OR
05
—
049072
—
OR
05
—
226666
—
OR
05
—
226667
—
OR
05
—
230426
—
OR
05
—
274689
—
OR
01
—
38D0624596
CLIA
OR
01
—
38D0624619
CLIA
OR
01
—
38D0888269
CLIA
OR
01
—
38D1059196
CLIA
OR
05
—
500620283
—
OR
05
—
500620284
—
OR
01
—
CE8055
RAILROAD GROUP PTAN
OR
Enumeration date
05/25/2007
Last updated
06/03/2020
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