Provider Demographics
NPI:1558397042
Name:NORTHWEST MEDICAL ASSOCIATES,PS
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL ASSOCIATES,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-254-8025
Mailing Address - Street 1:222 NE PARK PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5895
Mailing Address - Country:US
Mailing Address - Phone:360-254-8025
Mailing Address - Fax:360-254-8618
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:360-254-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7044142Medicaid
WACO3313OtherRAILROAD MEDICARE
WAG00068600Medicare PIN