Provider Demographics
NPI:1194812305
Name:NORTHWEST HEALTHCARE AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:NORTHWEST HEALTHCARE AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-7646
Mailing Address - Street 1:1516 JADWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2902
Mailing Address - Country:US
Mailing Address - Phone:509-946-7646
Mailing Address - Fax:509-946-7666
Practice Address - Street 1:1516 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2902
Practice Address - Country:US
Practice Address - Phone:509-946-7646
Practice Address - Fax:509-946-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952358954OtherNPI
WAPENDINGMedicaid
E08272Medicare UPIN
PENDINGMedicare ID - Type Unspecified