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General NPI Number Information
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NPI Number | 1154006492
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Entity Type | Organization
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Legal Business Name | NORTHWEST MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 938 W 3RD AVE
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City | MOSES LAKE
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State | WA
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Zip | 98837-2011
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Country | US
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Telephone | 509-350-4785
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Fax | 509-380-9591
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Provider Business Mailing Address
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Address Line | 938 W 3RD AVE
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City | MOSES LAKE
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State | WA
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Zip | 98837-2011
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Country | US
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Telephone | 509-350-4785
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON PENIX
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Credential | DO, MPH
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Telephone | 509-350-4785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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