Provider Demographics
NPI:1043513435
Name:NORTHWEST PHYSICIANS MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:NORTHWEST PHYSICIANS MEDICAL GROUP, PLLC
Other - Org Name:PHYSICAN CARE NW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-627-4638
Mailing Address - Street 1:708 BROADWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3778
Mailing Address - Country:US
Mailing Address - Phone:253-627-4638
Mailing Address - Fax:253-573-9511
Practice Address - Street 1:708 BROADWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3778
Practice Address - Country:US
Practice Address - Phone:253-627-4638
Practice Address - Fax:253-573-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty