Provider Demographics
NPI:1023053873
Name:NORTHWEST INTERNAL MEDICINE
Entity type:Organization
Organization Name:NORTHWEST INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SENKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-884-1210
Mailing Address - Street 1:PO BOX 49264
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-9264
Mailing Address - Country:US
Mailing Address - Phone:719-884-1210
Mailing Address - Fax:
Practice Address - Street 1:5390 N ACADEMY BLVD
Practice Address - Street 2:#300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4062
Practice Address - Country:US
Practice Address - Phone:719-884-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98539230Medicaid
CO98539230Medicaid