Provider Demographics
NPI:1609848514
Name:NORTHWEST MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOUTZENHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-276-6301
Mailing Address - Street 1:2841 DEBARR RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2932
Mailing Address - Country:US
Mailing Address - Phone:907-276-6301
Mailing Address - Fax:907-264-1541
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:SUITE 22
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-276-6301
Practice Address - Fax:907-264-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0154Medicaid
AKK0000WCHGFMedicare ID - Type Unspecified