Provider Demographics
NPI:1306487517
Name:NORTHWEST INTEGRATED HEALTH, LLP
Entity type:Organization
Organization Name:NORTHWEST INTEGRATED HEALTH, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BURK
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-490-1579
Mailing Address - Street 1:4109 W NEZ PERCE RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8864
Mailing Address - Country:US
Mailing Address - Phone:503-490-1579
Mailing Address - Fax:
Practice Address - Street 1:1250 WEST N. NORTHWOOD CENTER CT
Practice Address - Street 2:SUITE B
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-765-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care