1760475255 NPI number — HOSPICE OF SPOKANE

Table of content: (NPI 1760475255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760475255 NPI number — HOSPICE OF SPOKANE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF SPOKANE
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:
SPOKANE PALLIATIVE CARE & MOBILE MEDICINE OF SPOKANE
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:
1760475255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 S ARTHUR ST
Provider Second Line Business Mailing Address:
PO BOX 2215
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99202-2253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-456-0438
Provider Business Mailing Address Fax Number:
509-458-0359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 S ARTHUR ST
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:
99202-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-0438
Provider Business Practice Location Address Fax Number:
509-458-0359
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DRUMMOND
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-456-0438

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  IS-337 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: IHS FS 00000337 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3990165 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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