| Northwestern Healthcare Management Services Llc | |
|
4114 Bridgeport Way W University Place WA 98466-4315 | |
| (253) 564-4157 | |
| (253) 564-4813 |
| Full Name | Northwestern Healthcare Management Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4114 Bridgeport Way W, University Place, Washington |
| Authorized Official Name and Position | Mitra Hanjani (OWNER) |
| Authorized Official Contact | 2535644157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwestern Healthcare Management Services Llc 4114 Bridgeport Way W University Place WA 98466-4315 Ph: (253) 564-4157 | Northwestern Healthcare Management Services Llc 4114 Bridgeport Way W University Place WA 98466-4315 Ph: (253) 564-4157 |
| NPI Number | 1457873002 |
|---|---|
| Provider Enumeration Date | 07/14/2017 |
| Last Update Date | 07/28/2023 |
| Medicare PECOS PAC ID | 2365715026 |
|---|---|
| Medicare Enrollment ID | O20170831003358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457873002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kathryn Harshman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952537706 PECOS PAC ID: 1759435647 Enrollment ID: I20090811000721 |
| Provider Name | Mitra Hanjani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881897601 PECOS PAC ID: 9638358450 Enrollment ID: I20170831003389 |
| Provider Name | Mara Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770359218 PECOS PAC ID: 7911445804 Enrollment ID: I20240809001569 |
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