Provider Demographics
NPI:1548261308
Name:NORTHWEST MEDICAL SPECIALTIES PLLC
Entity type:Organization
Organization Name:NORTHWEST MEDICAL SPECIALTIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-428-8756
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:SUITE #305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-627-4285
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:SUITE #305
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-627-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB04710Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WA1301580001Medicare NSC