Provider Demographics
NPI:1043260227
Name:NORTHWEST INTERNAL MEDICINE TR
Entity Type:Organization
Organization Name:NORTHWEST INTERNAL MEDICINE TR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-1700
Mailing Address - Street 1:1560 N 115TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8414
Mailing Address - Country:US
Mailing Address - Phone:206-362-8337
Mailing Address - Fax:206-365-4398
Practice Address - Street 1:1560 N 115TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-362-8337
Practice Address - Fax:206-365-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026348207R00000X
WAMD00019848207R00000X
WAMD00019849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8863394Medicare PIN