Provider Demographics
NPI:1336268333
Name:MEDICAL RESOURCES NW PC
Entity type:Organization
Organization Name:MEDICAL RESOURCES NW PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:NIENDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-783-5301
Mailing Address - Street 1:2601 W FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3002
Mailing Address - Country:US
Mailing Address - Phone:509-783-5301
Mailing Address - Fax:509-783-5414
Practice Address - Street 1:2601 W FALLS AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3002
Practice Address - Country:US
Practice Address - Phone:509-783-5301
Practice Address - Fax:509-783-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043550207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI05732Medicare UPIN