Northwest Extremity Specialists LLC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

NORTHWEST EXTREMITY SPECIALISTS LLC

Practice address

12658 SE Stark St BLDG H
Portland, OR 97233-1058

Phone

(503) 221-1581

Fax

(503) 221-1582

NPI assigned

Mar 11, 2021

Organization subpart

Yes

Parent organization

NORTHWEST EXTREMITY SPECIALISTS LLCAs reported in NPPES

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

Authorized official

Name

Thomas Charles Melillo, DPM

Title

Owner

Phone

(503) 245-2420

Specialties & licenses 1

Addresses

Other names 1

• NES Gresham Other name

Part of

Northwest Extremity Specialists LLC

Locations

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1124603055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9115 SW OLESON RD STE 205",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236877",
            "telephone_number": "503-245-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12658 SE STARK ST BLDG H",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-221-1581",
            "fax_number": "503-221-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "MELILLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-245-2420",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NES Gresham",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Northwest Extremity Specialists LLC

• All providers in Portland, OR
• Podiatric Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.