Provider Demographics
NPI:1023065307
Name:COL NORTHWEST LLC
Entity type:Organization
Organization Name:COL NORTHWEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-774-7700
Mailing Address - Street 1:9200 SE 91ST AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3756
Mailing Address - Country:US
Mailing Address - Phone:503-774-7700
Mailing Address - Fax:503-774-7701
Practice Address - Street 1:9200 SE 91ST AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3756
Practice Address - Country:US
Practice Address - Phone:503-774-7700
Practice Address - Fax:503-774-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276104Medicaid
OR117583Medicare PIN