Provider Demographics
NPI:1033278411
Name:NORTHWEST GASTROENTEROLOGY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:NORTHWEST GASTROENTEROLOGY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-543-5054
Mailing Address - Street 1:3111 WOBURN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6610
Mailing Address - Country:US
Mailing Address - Phone:360-734-1420
Mailing Address - Fax:360-733-1659
Practice Address - Street 1:3111 WOBURN ST STE 201
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6610
Practice Address - Country:US
Practice Address - Phone:360-734-1420
Practice Address - Fax:360-733-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7048408Medicaid
WA7048408Medicaid