Provider Demographics
NPI:1811266745
Name:NORTHWEST MEDICAL SPECIALTY EVALUATIONS PLLC
Entity type:Organization
Organization Name:NORTHWEST MEDICAL SPECIALTY EVALUATIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-588-7340
Mailing Address - Street 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:STE#760
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0405
Mailing Address - Country:US
Mailing Address - Phone:509-588-7340
Mailing Address - Fax:509-588-7334
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:STE#760
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-588-7340
Practice Address - Fax:509-588-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
WAMD000482462081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty