Northwest Internal Medicine LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD24660 Issued in OR

Legal business name

NORTHWEST INTERNAL MEDICINE LLC

Practice address

19260 SW 65TH Ave Ste 270
Tualatin, OR 97062-5705

Phone

(503) 329-1851

Fax

(503) 885-8946

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Tana Marie Haynes, MD

Title

President

Phone

(503) 329-1851

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1932232741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 869",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970620869",
            "telephone_number": "503-329-1851",
            "fax_number": "503-885-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 270",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625705",
            "telephone_number": "503-329-1851",
            "fax_number": "503-885-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TANA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-329-1851",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD24660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029123",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.