1528163763 NPI number — SACRED HEART MEDICAL CENTER

Table of content: (NPI 1528163763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528163763 NPI number — SACRED HEART MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART MEDICAL CENTER
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:
1528163763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2555
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:
99220-2555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W 8TH AVE
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:
99204-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-3203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
RYLAND
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-474-3040

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  H-162 , 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: K0289 . This is a "SPHCO BCI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 3500022 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SA1390 . This is a "ASURIS OUTP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 02986 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 15 . This is a "BC/BS/PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 20 . This is a "GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G00611 . This is a "REG BLSH OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: SA1389 . This is a "ASURIS INPT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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