Basic Information
| Provider Information | |||||||||
| NPI: | 1144552704 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST PACIFIC EMERGENCY PHYSICIANS LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 952255 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753952255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669165259 | ||||||||
| FaxNumber: | 2319224030 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WEST FIFTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992100248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094585800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2010 | ||||||||
| LastUpdateDate: | 08/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | DERIK | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | LLP MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8669165259 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1144552704 | 05 | MT | MEDICAID | 2005590 | 05 | WA | MEDICAID | 500622220 | 05 | OR | MEDICAID | 1144552704 | 05 | WA | MEDICAID | 1144552704001 | 05 | ID | MEDICAID |