Provider Demographics
NPI:1043410194
Name:NORTHWEST HEALTH SUMMIT, PS
Entity Type:Organization
Organization Name:NORTHWEST HEALTH SUMMIT, PS
Other - Org Name:WOMAN'S HEALTH CONNECTION, PS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIENDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-465-8885
Mailing Address - Street 1:16201 E INDIANA AVE
Mailing Address - Street 2:SUITE 5300
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2830
Mailing Address - Country:US
Mailing Address - Phone:509-465-8885
Mailing Address - Fax:509-789-9013
Practice Address - Street 1:16201 E INDIANA AVE
Practice Address - Street 2:SUITE 5300
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2830
Practice Address - Country:US
Practice Address - Phone:509-465-8885
Practice Address - Fax:509-789-9013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST HEALTH SUMMIT, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X, 207R00000X, 207VG0400X, 2084P0800X, 363A00000X, 363L00000X, 363LF0000X
WAMD00045314207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMTSW.FS.60547341OtherWA DEPARTMENT OF HEALTH FACILITY IDENTIFICATION NUMBER
WA7131121Medicaid