Provider Demographics
NPI:1841236742
Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Entity Type:Organization
Organization Name:NORTHWEST HOSPITAL PROVIDERS TRUST
Other - Org Name:DBA MICHAEL K BRAWER MD
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:206-364-5000
Mailing Address - Street 1:1570 N 115TH ST
Mailing Address - Street 2:SUITE PB15
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8412
Mailing Address - Country:US
Mailing Address - Phone:206-368-6591
Mailing Address - Fax:206-368-1191
Practice Address - Street 1:1570 N 115TH ST
Practice Address - Street 2:SUITE PB15
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8412
Practice Address - Country:US
Practice Address - Phone:206-368-6591
Practice Address - Fax:206-368-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026431208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1295712651OtherNPI
WA8202814Medicaid
GABO3277Medicare ID - Type UnspecifiedMEDICARE
WAGAB03279Medicare UPIN