MEDICARE: NORTHWEST FAMILY PHYSICIANS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093721722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST FAMILY PHYSICIANS, P.A.

Provider Business Mailing Address
First Line	:	7920 MOORES CHAPEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9453
Country	:	US
Telephone Number	:	704-926-7800
Fax Number	:	704-926-7806

Provider Business Practice Location Address
First Line	:	7920 MOORES CHAPEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9453
Country	:	US
Telephone Number	:	704-926-7800
Fax Number	:	704-926-7806

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM G. LARSEN
Credential	:	M.D.
Telephone Number	:	704-926-7800

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/11/2010

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