Provider Demographics
NPI:1609059823
Name:NORTHWEST MEDICAL CLINIC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-972-2357
Mailing Address - Street 1:215 S 11TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3253
Mailing Address - Country:US
Mailing Address - Phone:509-248-6192
Mailing Address - Fax:
Practice Address - Street 1:215 S 11TH AVE STE D
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3253
Practice Address - Country:US
Practice Address - Phone:509-248-6192
Practice Address - Fax:509-965-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00008347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB17255Medicare PIN