Basic Information
| Provider Information | |||||||||
| NPI: | 1184271959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | ||||||||
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| OtherOrganizationName: | NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22068 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093442663 | ||||||||
| FaxNumber: | 5092328525 | ||||||||
| Practice Location | |||||||||
| Address1: | 12410 E SINTO AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099284334 | ||||||||
| FaxNumber: | 5099287893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUTTON | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALISTS, PS | ||||||||
| AuthorizedOfficialTelephone: | 5093433897 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHWEST ORTHOPAEDIC SPECIALISTS PS | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.