Healthcare Provider Details

I. General information

NPI: 1508068800
Provider Name (Legal Business Name): NORTHWEST AMBULATORY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 JADWIN AVE
RICHLAND WA
99352-3437
US

IV. Provider business mailing address

PO BOX 1408
RICHLAND WA
99352-1408
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-3340
  • Fax: 509-943-7909
Mailing address:
  • Phone: 509-946-3340
  • Fax: 509-943-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number50C0001170
License Number StateWA

VIII. Authorized Official

Name: BRENDEN MANAWADU
Title or Position: CEO
Credential:
Phone: 509-946-3340