Provider Demographics
NPI:1801818745
Name:NORTHWEST NEUROMUSCULAR ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHWEST NEUROMUSCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-438-2727
Mailing Address - Street 1:404-B BLACK HILLS LN SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8148
Mailing Address - Country:US
Mailing Address - Phone:360-438-2727
Mailing Address - Fax:360-923-1120
Practice Address - Street 1:404-B BLACK HILLS LN SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8148
Practice Address - Country:US
Practice Address - Phone:360-438-2727
Practice Address - Fax:360-923-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA06000041692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX IDENTIFICATION NUMBER