1003819319 NPI number — SACRED HEART MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003819319 NPI number — SACRED HEART MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1003819319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2555
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:
99220-2555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-474-3131
Provider Business Mailing Address Fax Number:
509-474-6846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W 8TH AVE
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:
99204-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-3131
Provider Business Practice Location Address Fax Number:
509-474-6846
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS SERVICES BILLING SUPERVISO
Authorized Official Telephone Number:
509-474-3131

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3500022 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3304201 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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