Healthcare Provider Details

I. General information

NPI: 1548261308
Provider Name (Legal Business Name): NORTHWEST MEDICAL SPECIALTIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 S I ST SUITE #305
TACOMA WA
98405-5016
US

IV. Provider business mailing address

1624 S I ST SUITE #305
TACOMA WA
98405-5016
US

V. Phone/Fax

Practice location:
  • Phone: 253-428-8700
  • Fax: 253-627-4285
Mailing address:
  • Phone: 253-428-8700
  • Fax: 253-627-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK NELSON
Title or Position: COO
Credential:
Phone: 253-428-8756