Provider Demographics
NPI:1336263649
Name:NORTHWEST PULMONOLOGY PHYSICIANS PC
Entity Type:Organization
Organization Name:NORTHWEST PULMONOLOGY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP & CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-336-8614
Mailing Address - Street 1:PO BOX 635704
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5704
Mailing Address - Country:US
Mailing Address - Phone:800-562-2945
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:206-364-2050
Practice Address - Fax:206-361-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7137912Medicaid
WA1055NOOtherBCBS
WA0220093OtherLABOR & IND STEVENS
WA0220096OtherLABOR & IND WA KINDRED
WA7139140Medicaid
WA8945381OtherVCR
WAG8865448Medicare PIN
WADG5057Medicare PIN