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NORTHWEST EXTREMITY SPECIALISTS LLC
NPI 1124603055
Clinic/Center - Podiatric in Portland, OR

Active since March 11, 2021
12658 SE STARK ST BLDG H, PORTLAND, OR 97233(503) 221-1581(503) 221-1582 Get Directions Write a Review

NPPES record last updated: March 11, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Northwest Extremity Specialists Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHWEST EXTREMITY SPECIALISTS LLC (NPI 1124603055) is a healthcare organization registered as a podiatric in Portland, Oregon and active in the NPI registry since March 2021. The organization lists Thomas Charles Melillo, Owner, as its authorized official.

NPPES Registry Identity

NPI1124603055
Entity TypeOrganization
Primary Taxonomy261QP1100X
Legal Business NameNORTHWEST EXTREMITY SPECIALISTS LLC
Location Address12658 SE STARK ST BLDG HPortland, OR 97233-1058
Mailing Address9115 Sw Oleson Rd Ste 205Tigard, OR 97223-6877 · (503) 245-2420
Phone(503) 221-1581
Fax(503) 221-1582
Organization SubpartYes
Authorized OfficialThomas Charles MelilloOwner · (503) 245-2420
Enumeration DateMarch 11, 2021
NPPES CertifiedMarch 11, 2021
✔ NPI 1124603055 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · PodiatricAmbulatory Health Care Facilities
Taxonomy Code261QP1100X
12658 SE STARK ST BLDG H, Portland, OR 97233
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Other Names 1

Other NameNes Gresham

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northwest Extremity Specialists LLC's NPI number?

The NPI number for Northwest Extremity Specialists LLC is 1124603055. It was assigned to this organization in the NPPES registry on March 11, 2021. The provider is also known as NES Gresham.

Where is Northwest Extremity Specialists LLC located?

Northwest Extremity Specialists LLC is located at 12658 SE Stark St Bldg H, Portland, OR 97233. The listed phone number is (503) 221-1581.

What is Northwest Extremity Specialists LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Podiatric, with taxonomy code 261QP1100X.

When was this NPI record last updated?

The NPPES record for Northwest Extremity Specialists LLC was last updated on March 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.