Provider Demographics
NPI:1497707368
Name:NORTHWEST MEDICAL PARTNERS
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-786-4133
Mailing Address - Street 1:280 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4133
Mailing Address - Fax:336-786-4338
Practice Address - Street 1:280 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2267
Practice Address - Country:US
Practice Address - Phone:336-786-4133
Practice Address - Fax:336-786-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203731BMedicare ID - Type Unspecified