Northwest Urology Clinic Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

NORTHWEST UROLOGY CLINIC INC

Practice address

1311 E Division St
Mount Vernon, WA 98274-4134

Phone

(360) 424-7991

Fax

(360) 424-5441

NPI assigned

Sep 14, 2005

Last updated

Sep 6, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eva Samtmann

Title

Administrator

Phone

(360) 424-7991

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darrell R. Cornelius, MD

  • Urology Physician
  • Mount Vernon, WA
  • NPI 1639270812
  NPD
• Billy Pitapong Vanasupa, D.O.

  • Urology Physician
  • St Augustine, FL
  • NPI 1689774507
  NPD
• Courtney A. Shick, PA-C

  • Medical Physician Assistant
  • Silverdale, WA
  • NPI 1003066432
  NPD (past)
• Bret A Moore, PA-C

  • Physician Assistant
  • Ottumwa, IA
  • NPI 1639108004
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1407841562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 E DIVISION ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744134",
            "telephone_number": "360-424-7991",
            "fax_number": "360-424-5441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 E DIVISION ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744134",
            "telephone_number": "360-424-7991",
            "fax_number": "360-424-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST UROLOGY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-14",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "SAMTMANN",
        "authorized_official_first_name": "EVA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-424-7991"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northwest Dental Sleep & Wellness Center
• Northwest Orthopaedic Surgeons, P.S.
• Northwest Pathology PLLC (Avero Diagnostics)
• Northwest Physical Therapy Sports Rehabilitation Center, Inc., P.S.
• Northwest Return to Work Mt Vernon (Valley Rehab PT AND RTW CENTER)
• Ann Bouska Novak
• Matthew John Novak, MD
• Maria Guadalupe Nunez Michel
• Tom A O'Brien-Wilson
• Joy O'Brien

• Urology Physician in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.