1891982385 NPI number — CAROL R GUTHRIE MD

Table of content: (NPI 1891982385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891982385 NPI number — CAROL R GUTHRIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL R GUTHRIE MD
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:
6
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:
1891982385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 W 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-455-9550
Provider Business Mailing Address Fax Number:
509-456-3342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-9550
Provider Business Practice Location Address Fax Number:
509-456-3342
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUTHRIE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-455-9550

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD00032018 , 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: 7118524 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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