Provider Demographics
NPI:1316023567
Name:NORTHWEST PSYCHIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:NORTHWEST PSYCHIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:ULLRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-765-0955
Mailing Address - Street 1:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1356
Mailing Address - Country:US
Mailing Address - Phone:208-765-0955
Mailing Address - Fax:208-765-6972
Practice Address - Street 1:1115 IRONWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4936
Practice Address - Country:US
Practice Address - Phone:208-765-0955
Practice Address - Fax:208-765-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty