Col Northwest LLC – Physiological Laboratory

Key facts

NPI: 1023065307
Entity type: Organization (NPI type 2)
Primary specialty: Physiological Laboratory 293D00000X
Legal business name: COL NORTHWEST LLC
Practice address: 9200 SE 91St Ave
Suite 330
Happy Valley, OR 97086-3756
Phone: (503) 774-7700
Fax: (503) 774-7701
NPI assigned: May 30, 2006
Organization subpart: No

Authorized official

Name: Darcy E. Orin
Title: Ceo
Phone: (503) 774-7700

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Eastside Orthopedics & Sports Medicine, LLC Orthopaedic Surgery Physician · Clackamas, OR · NPI 1225567928

NPD member Member Of
Oregon Orthopedic & Sports Medicine Clinic, LLP Orthopaedic Surgery Physician · Oregon City, OR · NPI 1588762736

NPD member Member Of

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Amy Suzanne Thurmond, MD Diagnostic Radiology Physician · Lake Oswego, OR · NPI 1487729281

NPD
Lisa Ona Ballehr, D.O. Diagnostic Radiology Physician · Brentwood, TN · NPI 1417996018

NPD
Purvak Patel, M.D. Diagnostic Radiology Physician · Wichita Falls, TX · NPI 1528293842

NPD
Prashant Vijay Shankar, MD Diagnostic Radiology Physician · Atlanta, GA · NPI 1134353378

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in OR

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040317000296	OR	Part B Supplier - Independent Diagnostic Testing Facility (Idtf)	2769372424	Practice locations: Happy Valley, OR

National Provider Directory

Locations

9200 SE 91st Ave
Ste 330
Portland, OR 97086
Phone (503) 774-7700

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physiological Laboratory	293D00000X			Yes

Addresses

Primary practice location

9200 SE 91St Ave
Suite 330
Happy Valley, OR 97086-3756

Mailing address

9200 SE 91St Ave
Suite 330
Happy Valley, OR 97086-3756
Phone (503) 774-7700

Other identifiers

Identifier	Type	State	Issuer
276104	Medicaid	OR

Other names

Clearview MRI Mt Scott Doing business as

Other providers in Happy Valley, OR

All providers in Happy Valley, OR · Physiological Laboratory in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.