Provider Demographics
NPI:1275567919
Name:NORTHWEST PHYSICIAN ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHWEST PHYSICIAN ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-251-6901
Mailing Address - Street 1:PO BOX 634596
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4596
Mailing Address - Country:US
Mailing Address - Phone:800-562-2945
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:330 S STILLAGUAMISH AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1642
Practice Address - Country:US
Practice Address - Phone:360-435-2133
Practice Address - Fax:253-838-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7100183Medicaid
OR288344Medicaid
WA7135510Medicaid
WA7136047Medicaid
WY112256800Medicaid
WA7131352Medicaid
WA7200124Medicaid
WA7200124Medicaid
WAG8855776Medicare PIN
WACH2242Medicare PIN
WAGAB13804Medicare PIN
WA7100183Medicaid
WY112256800Medicaid
ORR107994Medicare PIN
ORCH5025Medicare PIN
WAGAB14299Medicare PIN
WYW21184Medicare PIN
WAG8850856Medicare PIN
ORR131330Medicare PIN
WAG8850392Medicare PIN
WAGAB14298Medicare PIN