Provider Demographics
NPI:1720023823
Name:NORTHWEST HOSPITAL
Entity Type:Organization
Organization Name:NORTHWEST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-1738
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-368-6572
Mailing Address - Fax:206-369-6562
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-368-6572
Practice Address - Fax:206-369-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD21915261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1091891Medicaid
A05252Medicare UPIN
AB15696Medicare ID - Type Unspecified