1982799110 NPI number — COLUMBIA MEDICAL ASSOCIATES

Table of content: (NPI 1982799110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982799110 NPI number — COLUMBIA MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA MEDICAL ASSOCIATES
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:
FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
5
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:
1982799110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2808
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:
99220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-688-6733
Provider Business Mailing Address Fax Number:
509-688-6792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE #600
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-9800
Provider Business Practice Location Address Fax Number:
509-455-6913
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHOBER-KLOTZ
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PROVIDER RELATIONS MANAGER
Authorized Official Telephone Number:
509-688-6733

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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