1477934578 NPI number — MT. SPOKANE PEDIATRICS, PLLC

Table of content: (NPI 1477934578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477934578 NPI number — MT. SPOKANE PEDIATRICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT. SPOKANE PEDIATRICS, PLLC
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:
1477934578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
759 E HOLLAND AVE
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:
99218-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-270-0065
Provider Business Mailing Address Fax Number:
509-319-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
759 E HOLLAND AVE STE 101
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:
99218-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-270-0065
Provider Business Practice Location Address Fax Number:
509-319-2520
Provider Enumeration Date:
06/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ROOT
Authorized Official First Name:
TAYLOR
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
509-270-0065

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XF0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; 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" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1760195382 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881434975 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP61351087 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023617347 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1306689278 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477189785 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477934578 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1609330992 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP60929537 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP61335304 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: SI61064749 . This is a "SLP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1447988530 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP60228997 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP60327358 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: OT60064658 . This is a "OT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1366298085 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP60942013 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP61315755 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP60919324 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP61109016 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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