Provider Demographics
NPI:1407841562
Name:NORTHWEST UROLOGY CLINIC INC
Entity Type:Organization
Organization Name:NORTHWEST UROLOGY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-424-7991
Mailing Address - Street 1:1311 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4134
Mailing Address - Country:US
Mailing Address - Phone:360-424-7991
Mailing Address - Fax:360-424-5441
Practice Address - Street 1:1311 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4134
Practice Address - Country:US
Practice Address - Phone:360-424-7991
Practice Address - Fax:360-424-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty