Northwest Surgical Development

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

16741689 Issued in OR

Legal business name

NORTHWEST SURGICAL DEVELOPMENT

Doing business as

Athenix Body Sculpting

Practice address

17885 NW Evergreen Pkwy
Beaverton, OR 97006-7494

Phone

(971) 246-5291

NPI assigned

Jul 12, 2017

Last updated

Jul 12, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christina Gillett

Title

Insurance Specialist

Phone

(949) 600-9941

Specialties & licenses 1

Addresses

Other names 1

• Athenix Body Sculpting Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1023530094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 ENTERPRISE STE 125",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926562706",
            "telephone_number": "949-600-9941",
            "fax_number": "949-600-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17885 NW EVERGREEN PKWY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067494",
            "telephone_number": "971-246-5291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SURGICAL DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "GILLETT",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "949-600-9941"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "OR",
            "license": "16741689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athenix Body Sculpting",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Athenix Body Sculpting",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northwest Mobile Imaging, LLC
• Northwest Mobile Services LLC
• Northwest Occupational Medicine Center Inc.
• Northwest Regional Education Service District
• Northwest RTB9 LLC (Relax the Back)
• Ryan M. Norton, D.O.
• Nova Spinal Rehabilition LLC (Oregon spine and disc)
• John Kennan Novack
• Novam-Nutrition LLC
• Novella Haven LLC Residential Care

• Plastic and Reconstructive Surgery Physician in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Plastic and Reconstructive Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.