Provider Demographics
NPI:1578817078
Name:NORTHWEST SPINE AND LASER SURGERY CENTER LLC
Entity type:Organization
Organization Name:NORTHWEST SPINE AND LASER SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-6886
Mailing Address - Street 1:8995 SW MILEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5484
Mailing Address - Country:US
Mailing Address - Phone:267-760-4734
Mailing Address - Fax:
Practice Address - Street 1:8995 SW MILEY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5484
Practice Address - Country:US
Practice Address - Phone:267-760-4734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical