Healthcare Provider Details

I. General information

NPI: 1851902605
Provider Name (Legal Business Name): NORTHWEST CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 301C
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 301C
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-339-7078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WIL EDWARDS
Title or Position: OWNER
Credential: PHARMD
Phone: 509-339-7078