Provider Demographics
NPI:1609071570
Name:NORTHWEST GYNECOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NORTHWEST GYNECOLOGY ASSOCIATES PLLC
Other - Org Name:WOMEN'S CENTER FOR OPTIMUM HEALTH PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-4024
Mailing Address - Street 1:406 SE 131ST AVE BLDG C
Mailing Address - Street 2:SUITE 304
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4004
Mailing Address - Country:US
Mailing Address - Phone:360-892-4024
Mailing Address - Fax:360-892-4159
Practice Address - Street 1:406 SE 131ST AVE BLDG C
Practice Address - Street 2:SUITE 304
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-892-4024
Practice Address - Fax:360-892-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29691Medicare ID - Type UnspecifiedGROUP NUMBER