MEDICARE: NORTHWEST HOSPITAL LLC

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	261QE0002X	Emergency Care Clinic/Center	H0152	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528505187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HOSPITAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 848444
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8444
Country	:	US
Telephone Number	:	520-742-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10146 E OLD VAIL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9406
Country	:	US
Telephone Number	:	520-547-7400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/DELEGATED OFFICIAL
Name	:	PAULA LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	04/29/2021

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