Provider Demographics
NPI:1770545352
Name:NORTHWEST HOSPITAL PROVIDER TRUST
Entity type:Organization
Organization Name:NORTHWEST HOSPITAL PROVIDER TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-6572
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8421
Mailing Address - Country:US
Mailing Address - Phone:206-368-6560
Mailing Address - Fax:206-368-6562
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8421
Practice Address - Country:US
Practice Address - Phone:206-368-6560
Practice Address - Fax:206-368-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADB5811OtherRAILROAD MEDICARE
G8801320Medicare PIN