1083607477 NPI number — SPOKANE RADIATION ONCOLOGY ASSOCIATES P S

Table of content: (NPI 1083607477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083607477 NPI number — SPOKANE RADIATION ONCOLOGY ASSOCIATES P S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPOKANE RADIATION ONCOLOGY ASSOCIATES 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:
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:
1083607477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405
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:
99210-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-667-9334
Provider Business Mailing Address Fax Number:
208-664-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W IRONWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-666-3800
Provider Business Practice Location Address Fax Number:
208-666-3817
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVENPORT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
208-666-3800

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CN8904 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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