Provider Demographics
NPI:1346376357
Name:NORTHWEST INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:NORTHWEST INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:509-926-1299
Mailing Address - Street 1:801 W 5TH AVE
Mailing Address - Street 2:STE 407
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2841
Mailing Address - Country:US
Mailing Address - Phone:509-755-0372
Mailing Address - Fax:509-232-6509
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:STE 407
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2841
Practice Address - Country:US
Practice Address - Phone:509-755-0372
Practice Address - Fax:509-232-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120988OtherLABOR & INDUSTRIES
WAP00400206OtherRAILROAD MEDICARE
WA1123785Medicaid
WAG67285Medicare UPIN
WA1123785Medicaid