Basic Information
Provider Information
NPI: 1932166337
EntityType: 2
ReplacementNPI:  
OrganizationName: NORTHWEST HEART CARE LLC
LastName:  
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Mailing Information
Address1: PO BOX 821350
Address2:  
City: VANCOUVER
State: CO
PostalCode: 986820030
CountryCode: US
TelephoneNumber: 5032835220
FaxNumber: 5032839527
Practice Location
Address1: 9155 SW BARNES RD
Address2: SUITE 204
City: PORTLAND
State: OR
PostalCode: 97225
CountryCode: US
TelephoneNumber: 5032970541
FaxNumber: 5032164079
Other Information
ProviderEnumerationDate: 04/28/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: PHILLIPS
AuthorizedOfficialFirstName: CHRISTOPHER
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AuthorizedOfficialTitleorPosition: BILLING MANAGER
AuthorizedOfficialTelephone: 3605673284
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: CPC
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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