1689674244 NPI number — E.A. SOHN INC., P.S.

Table of content: (NPI 1689674244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689674244 NPI number — E.A. SOHN INC., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E.A. SOHN INC., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INDIAN TRAIL GERIATRIC MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689674244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1818 W FRANCIS AVE # 385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99205-6834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-464-1600
Provider Business Mailing Address Fax Number:
509-343-9391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 W RIVERSIDE AVE STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-1600
Provider Business Practice Location Address Fax Number:
509-343-9391
Provider Enumeration Date:
07/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOHN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-869-7533

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD37099 . This is a "WA LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MD7619 . This is a "IDAHO LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1016357 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".