MEDICARE: NORTHWEST HBP MEDICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208M00000X	Hospitalist Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	367500000X	Certified Registered Nurse Anesthetist
5	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1255140521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HBP MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 680060
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-0060
Country	:	US
Telephone Number	:	877-848-1457
Fax Number	:	659-235-6176

Provider Business Practice Location Address
First Line	:	10146 E OLD VAIL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9406
Country	:	US
Telephone Number	:	877-848-1457
Fax Number	:	659-235-6176

Authorized Official
Title or Position	:	SR. DIRECTOR
Name	:	WENDI KEETON
Credential	:
Telephone Number	:	615-628-6507

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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