Provider Demographics
NPI:1073579850
Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Entity Type:Organization
Organization Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Other - Org Name:NORTHWEST HOSPITAL PROVIDER TRUST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NWH CLINIC BUSINESS OFFICE, MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-3051
Mailing Address - Street 1:PO BOX 33450
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-0450
Mailing Address - Country:US
Mailing Address - Phone:206-368-1244
Mailing Address - Fax:
Practice Address - Street 1:1560 N 115TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-368-1244
Practice Address - Fax:206-368-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9629890Medicaid
WAG8803190Medicare PIN