1750521720 NPI number — SPOKANE VALLEY EAR NOSE & THROAT PS

Table of content: (NPI 1750521720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750521720 NPI number — SPOKANE VALLEY EAR NOSE & THROAT PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPOKANE VALLEY EAR NOSE & THROAT PS
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:
1750521720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 N MCDONALD RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99216-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-928-7272
Provider Business Mailing Address Fax Number:
509-928-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1424 N. MCDONALD RD
Provider Second Line Business Practice Location Address:
SUITE 102
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-7272
Provider Business Practice Location Address Fax Number:
509-928-7346
Provider Enumeration Date:
03/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JULIAN
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
GARRISON
Authorized Official Title or Position:
SEC/TRES
Authorized Official Telephone Number:
509-928-7272

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASF.FS.60129513 , 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: 0257384 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010221 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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