MEDICARE: NORTHWEST PULMONARY PHYSICIANS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	447606227001	OTHER	OK	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1174548127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PULMONARY PHYSICIANS PC

Provider Business Mailing Address
First Line	:	3201 N VAN BUREN ST
Second Line	:	SUITE 400
City	:	ENID
State	:	OK
Zip	:	73703-1800
Country	:	US
Telephone Number	:	580-237-1877
Fax Number	:	580-237-2872

Provider Business Practice Location Address
First Line	:	3201 N VAN BUREN ST
Second Line	:	SUITE 400
City	:	ENID
State	:	OK
Zip	:	73703-1800
Country	:	US
Telephone Number	:	580-237-1877
Fax Number	:	580-237-2872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN D WHITSON
Credential	:	M.D.
Telephone Number	:	580-237-1877

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/24/2007

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