Provider Demographics
NPI:1588424345
Name:NORTHWEST HEALTH PLC
Entity type:Organization
Organization Name:NORTHWEST HEALTH PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MAJORITY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-948-6159
Mailing Address - Street 1:822 BLACK BULL TRL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9686
Mailing Address - Country:US
Mailing Address - Phone:732-948-6159
Mailing Address - Fax:
Practice Address - Street 1:2952 TECHNOLOGY BLVD W STE 217
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4145
Practice Address - Country:US
Practice Address - Phone:406-414-6607
Practice Address - Fax:406-604-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty