Provider Demographics
NPI:1033242193
Name:SPOKANE DIGESTIVE DISEASE CENTER
Entity Type:Organization
Organization Name:SPOKANE DIGESTIVE DISEASE CENTER
Other - Org Name:SDDC NORTH ASC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-838-5950
Mailing Address - Street 1:46 E ROWAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1232
Mailing Address - Country:US
Mailing Address - Phone:509-487-1669
Mailing Address - Fax:509-487-7773
Practice Address - Street 1:46 E ROWAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1232
Practice Address - Country:US
Practice Address - Phone:509-487-1669
Practice Address - Fax:509-487-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00056575261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA07164Medicare UPIN
WAG72561Medicare UPIN
WAF15999Medicare UPIN