MEDICARE: NORTHWEST COLON AND RECTAL CLINIC

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780793711	OTHER		NP1

General Provider Information

NPI Number	:	1215092929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST COLON AND RECTAL CLINIC

Provider Business Mailing Address
First Line	:	1101 MADISON ST
Second Line	:	SUITE 500
City	:	SEATTLE
State	:	WA
Zip	:	98104-1306
Country	:	US
Telephone Number	:	206-386-6600
Fax Number	:	206-386-2452

Provider Business Practice Location Address
First Line	:	1101 MADISON ST
Second Line	:	SUITE 500
City	:	SEATTLE
State	:	WA
Zip	:	98104-1306
Country	:	US
Telephone Number	:	206-386-6600
Fax Number	:	206-386-2452

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DENISE GWINN
Credential	:
Telephone Number	:	206-386-6600

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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