Provider Demographics
NPI:1588765739
Name:NORTHWEST ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:NORTHWEST ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:N
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-734-1420
Mailing Address - Street 1:3111 WOBURN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6610
Mailing Address - Country:US
Mailing Address - Phone:360-734-1420
Mailing Address - Fax:360-733-1659
Practice Address - Street 1:3111 WOBURN ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6610
Practice Address - Country:US
Practice Address - Phone:360-734-1420
Practice Address - Fax:360-733-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601886708261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7090533Medicaid
WAGAB05904Medicare ID - Type Unspecified
WA7090533Medicaid