Provider Demographics
NPI:1073608733
Name:NORTHWEST MEDICAL INC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL INC
Other - Org Name:HURFORD 2 INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-726-6928
Mailing Address - Street 1:5601 E 18TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6886
Mailing Address - Country:US
Mailing Address - Phone:360-726-6928
Mailing Address - Fax:360-828-5769
Practice Address - Street 1:5601 E 18TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6886
Practice Address - Country:US
Practice Address - Phone:360-726-6928
Practice Address - Fax:360-828-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601 544 278332B00000X, 332BN1400X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR208346Medicaid
ID03306400Medicaid
WA9039322Medicaid
WA9039272Medicaid
OR819727000OtherREGENCE BCBS
ORNP0064433 01OtherREGENCE BCBS HMO
WA0034035OtherLABOR AND INDUSTRIES
WA9039777Medicaid
=========OtherUNIFORM INSURANCE CO
WA9039777Medicaid
WA9039322Medicaid
ID03306400Medicaid