Basic Information
| Provider Information | |||||||||
| NPI: | 1235172370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST EMERGENCY PHYSICIANS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HOPYARD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945883348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008379910 | ||||||||
| FaxNumber: | 9259240506 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 S STILLAGUAMISH AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252516901 | ||||||||
| FaxNumber: | 9259240506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARDY | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9252516901 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2164NO | 01 | WA | BSWA | OTHER | 7100167 | 05 | WA | MEDICAID | 7135510 | 05 | WA | MEDICAID | 7142078 | 05 | WA | MEDICAID | 000010140860 | 01 | ID | BSID | OTHER | 041428000 | 01 | OR | BSOR | OTHER | 7136047 | 05 | WA | MEDICAID | 8G312 | 01 | ID | BSID | OTHER | 25349000 | 01 | OR | BCBS | OTHER | 4570NO | 01 | WA | BSWA | OTHER | 7140692 | 05 | WA | MEDICAID | 1450NO | 01 | WA | BSWA | OTHER | 288344 | 05 | OR | MEDICAID | 5075NO | 01 | WA | BCBS | OTHER | 7142128 | 05 | WA | MEDICAID | 112256800 | 05 | WY | MEDICAID | 167530 | 05 | OR | MEDICAID | 7118052 | 05 | WA | MEDICAID | 7131352 | 05 | WA | MEDICAID | 806617300 | 05 | WA | MEDICAID | JE8081 | 01 | WA | BSWA | OTHER | 3575NO | 01 | WA | BSWA | OTHER | 7100175 | 05 | WA | MEDICAID | 7200124 | 05 | WA | MEDICAID | 288336 | 05 | OR | MEDICAID | 3066NO | 01 | WA | BSWA | OTHER | 7100183 | 05 | WA | MEDICAID | 806476500 | 05 | ID | MEDICAID |