1508834565 NPI number — SCOTT W NYE MD

Table of content: SCOTT W NYE MD (NPI 1508834565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508834565 NPI number — SCOTT W NYE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYE
Provider First Name:
SCOTT
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508834565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2010
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:
STE 7060
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:
509-747-6194
Provider Business Mailing Address Fax Number:
509-838-0824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 N HOUK RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-1376
Provider Business Practice Location Address Fax Number:
509-921-9763
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD00037585 , 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: 8243024 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00206017 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0189201 . This is a "DEPT OF LABOR & INDUSTRY" identifier . This identifiers is of the category "OTHER".




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