Provider Demographics
NPI:1578006599
Name:NORTHWEST MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:253-428-8700
Mailing Address - Street 1:1624 SOUTH I STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-383-3376
Practice Address - Street 1:11511 CANTERWOOD BLVD
Practice Address - Street 2:SUITE 45
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-858-4725
Practice Address - Fax:253-858-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60711956364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncologyGroup - Multi-Specialty