1578636064 NPI number — PEDIATRIC ASSOCIATES OF SPOKANE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578636064 NPI number — PEDIATRIC ASSOCIATES OF SPOKANE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ASSOCIATES 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:
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:
1578636064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
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:
418
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:
509-747-3081
Provider Business Mailing Address Fax Number:
509-343-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W 8TH AVE
Provider Second Line Business Practice Location Address:
418
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-3081
Provider Business Practice Location Address Fax Number:
509-343-1102
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
509-747-3081

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , 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)





Copyright © 2007-2025 www.npivalidator.com