Basic Information
| Provider Information | |||||||||
| NPI: | 1336263649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST PULMONOLOGY PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635704 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005622945 | ||||||||
| FaxNumber: | 2538386418 | ||||||||
| Practice Location | |||||||||
| Address1: | 21601 76TH AVE W | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063642050 | ||||||||
| FaxNumber: | 2063615722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP & CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8003368614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 7137912 | 05 | WA | MEDICAID | 1055NO | 01 | WA | BCBS | OTHER | 0220093 | 01 | WA | LABOR & IND STEVENS | OTHER | 0220096 | 01 | WA | LABOR & IND WA KINDRED | OTHER | 7139140 | 05 | WA | MEDICAID | 8945381 | 01 | WA | VCR | OTHER |