Healthcare Provider Details

I. General information

NPI: 1023448321
Provider Name (Legal Business Name): NORTHWEST HOSPITALIST PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 S MONROE MEDICAL PARK BLVD
BLOOMINGTON IN
47403-8000
US

IV. Provider business mailing address

75 REMIT DR SUITE 1122
CHICAGO IL
60675-1122
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-1111
  • Fax: 812-825-0752
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential:
Phone: 866-916-5259