Northwest Geriactrics

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

Legal business name

NORTHWEST GERIACTRICS

Practice address

10365 SE Sunnyside Rd Ste 340
Clackamas, OR 97015-5751

Phone

(143) 586-2614

NPI assigned

May 28, 2020

Last updated

May 28, 2020By 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

Mark L Phillips, MBA/MHA

Title

President

Phone

(435) 862-6143

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1639793367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N 2100 W STE 202",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841164741",
            "telephone_number": "435-862-6143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10365 SE SUNNYSIDE RD STE 340",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155751",
            "telephone_number": "143-586-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST GERIACTRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-862-6143",
        "authorized_official_credential": "MBA/MHA"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North America Mattress Corp.
• North America Mattress Corporation
• Northland Hearing Centers, Inc.
• Northwest Eye Care LLC (Northwest Eye Care Professionals)
• Northwest Family Psychology
• Northwest Medical, LLC.
• Northwest Renal Clinic, Inc.
• Karie Grace Nosack
• Nancy Novig, CRNA, MS
• James Alexander Novotny, FNP

• Hospice and Palliative Medicine (Family Medicine) Physician in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.