Healthcare Provider Details

I. General information

NPI: 1407127442
Provider Name (Legal Business Name): NORTHWEST PHYSICIAN ASSOCIATES, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 336TH ST SUITE 600
FEDERAL WAY WA
98003-5947
US

IV. Provider business mailing address

505 S 336TH ST SUITE 600
FEDERAL WAY WA
98003-5947
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-6180
  • Fax: 253-838-6418
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON HARDY
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 925-251-6901