Healthcare Provider Details

I. General information

NPI: 1073608733
Provider Name (Legal Business Name): NORTHWEST MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 E 18TH ST STE 102
VANCOUVER WA
98661-6886
US

IV. Provider business mailing address

5601 E 18TH ST STE 102
VANCOUVER WA
98661-6886
US

V. Phone/Fax

Practice location:
  • Phone: 360-726-6928
  • Fax: 360-828-5769
Mailing address:
  • Phone: 360-726-6928
  • Fax: 360-828-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number601 544 278
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number601 544 278
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number601 544 278
License Number StateWA

VIII. Authorized Official

Name: MEGAN J WALETICH
Title or Position: OWNER
Credential:
Phone: 360-726-6928