Verification Lookup Portal
Providers for Global Mode
Northwest Specialty Hospital
Provider Last Name
Last name is required.
Provider First Name
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Provider Birthdate
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Please provide a valid Date.
Provider NPI
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NPI number is invalid. Must be a ten-digit number.
Required Information
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Requester Name
Name is required.
Requester Title
Title is required.
Requester Organization
Organization is required.
Requester Address
Address is required.
Requester City, State, Zip
City, State, Zip is required.
Requester Phone
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Requester Fax
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Requester Email
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I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies Northwest Specialty Hospital and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such Northwest Specialty Hospital and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with Northwest Specialty Hospital.
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Please Enter the Following Information:
Facility
Provider Last Name
Provider First Name
Provider Birthdate
Provider NPI
Requester Name
Requester Title
Requester Organization
Requester Address
Requester City, State, Zip
Requester Phone
Requester Fax
Requester Email