Provider Demographics
NPI:1174934707
Name:NW MAGNUM LLC
Entity type:Organization
Organization Name:NW MAGNUM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNYAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-576-0021
Mailing Address - Street 1:108 CENTRAL WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6106
Mailing Address - Country:US
Mailing Address - Phone:425-576-0021
Mailing Address - Fax:
Practice Address - Street 1:108 CENTRAL WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6106
Practice Address - Country:US
Practice Address - Phone:425-576-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANDING335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier