Organization
NORTHWEST EXTREMITY SPECIALISTS LLC
Active
Parent organization
NORTHWEST EXTREMITY SPECIALISTS LLC
Other names
NES Newberg Providence
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHWEST EXTREMITY SPECIALISTS LLC
Authorized official
THOMAS CHARLES MELILLO DPM (OWNER)
(503) 245-2420
Entity
Organization
Contact information
Practice address
1000 N PROVIDENCE DR STE 320, NEWBERG, OR 97132-7582
(503) 245-2420
(503) 245-2445
Mailing address
9115 SW OLESON RD STE 205, PORTLAND, OR 97223-6877
(503) 245-2420
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
03/11/2021
Last updated
03/11/2021
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