Provider Demographics
NPI:1588662324
Name:NORTHWEST HEART & LUNG SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHWEST HEART & LUNG SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-456-0262
Mailing Address - Street 1:910 W 5TH AVE
Mailing Address - Street 2:STE 380
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2966
Mailing Address - Country:US
Mailing Address - Phone:509-456-0262
Mailing Address - Fax:509-462-5059
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:STE 330
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-456-0262
Practice Address - Fax:509-462-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL0501975208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7294903Medicaid
WA7294903Medicaid
WAGAB18195Medicare PIN