| Sports Health Northwest Inc | |
|
12672 Nw Barnes Rd Ste 100 Portland OR 97229-6191 | |
| (503) 747-6376 | |
| (503) 530-8406 |
| Full Name | Sports Health Northwest Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 12672 Nw Barnes Rd Ste 100, Portland, Oregon |
| Authorized Official Name and Position | David N Westerdahl (OWNER) |
| Authorized Official Contact | 5037476376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sports Health Northwest Inc 12672 Nw Barnes Rd Ste 100 Portland OR 97229-6191 Ph: (503) 747-6376 | Sports Health Northwest Inc 12672 Nw Barnes Rd Ste 100 Portland OR 97229-6191 Ph: (503) 747-6376 |
| NPI Number | 1346863727 |
|---|---|
| Provider Enumeration Date | 05/20/2020 |
| Last Update Date | 10/24/2020 |
| Medicare PECOS PAC ID | 2668894411 |
|---|---|
| Medicare Enrollment ID | O20200624000579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346863727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Leah W Gaedeke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336185677 PECOS PAC ID: 3072505346 Enrollment ID: I20080717000251 |
| Provider Name | David N Westerdahl |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1356305023 PECOS PAC ID: 3577523885 Enrollment ID: I20180608001685 |
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