Provider Demographics
NPI:1053348516
Name:NORTHWEST HOSPITAL
Entity type:Organization
Organization Name:NORTHWEST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-1738
Mailing Address - Street 1:1570 N 115TH ST
Mailing Address - Street 2:#9
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8412
Mailing Address - Country:US
Mailing Address - Phone:206-362-5654
Mailing Address - Fax:206-368-1566
Practice Address - Street 1:1570 N 115TH ST
Practice Address - Street 2:# 9
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8412
Practice Address - Country:US
Practice Address - Phone:206-362-5654
Practice Address - Fax:206-368-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016487207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG4487OtherRAILROAD MEDICARE
G8806331OtherEMILY BRADLEY MD
GAB15691OtherLESLIE NEWTON MED GRP
WACG4487OtherRAILROAD MEDICARE