Provider Demographics
NPI:1780636290
Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Entity Type:Organization
Organization Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Other - Org Name:DEEP BRAIN STIMULATION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-364-0500
Mailing Address - Street 1:PO BOX 33230
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-0230
Mailing Address - Country:US
Mailing Address - Phone:206-368-5935
Mailing Address - Fax:206-368-5934
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-368-5935
Practice Address - Fax:206-368-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005312163W00000X
WAAP30006736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11509436OtherCAQH SCHUMAN
WA11543704OtherCAQH HERRING
WAG8802394Medicare PIN