Provider Demographics
NPI:1417985052
Name:NORTHWEST HOSPITAL DBA CHAU SU OU MD
Entity Type:Organization
Organization Name:NORTHWEST HOSPITAL DBA CHAU SU OU MD
Other - Org Name:CHAU SU OU MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-364-0500
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 372
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-368-6175
Mailing Address - Fax:206-368-6121
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 372
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-368-6175
Practice Address - Fax:206-368-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00019674OtherMD LICENSE
WA10999928Medicaid
WAGAB17502Medicare PIN
WAAB17503Medicare UPIN