1346376357 NPI number — NORTHWEST INTERNAL MEDICINE, PLLC

Table of content: (NPI 1346376357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346376357 NPI number — NORTHWEST INTERNAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST INTERNAL MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346376357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 W 5TH AVE
Provider Second Line Business Mailing Address:
STE 407
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-755-0372
Provider Business Mailing Address Fax Number:
509-232-6509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W 5TH AVE
Provider Second Line Business Practice Location Address:
STE 407
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-755-0372
Provider Business Practice Location Address Fax Number:
509-232-6509
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOSS
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
509-926-1299

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD00035833 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120988 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00400206 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1123785 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com