Provider Demographics
NPI:1063481620
Name:OSTLIE, TODD A (PA-C)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:OSTLIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:212 E CENTRAL AVE
Practice Address - Street 2:STE 140
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6289
Practice Address - Country:US
Practice Address - Phone:509-465-1300
Practice Address - Fax:509-465-1313
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA19618OtherGROUP HEALTH NW
WA5035OSOtherASURIS NW HEALTH
WA152849OtherDEPT OF LABOR & INDUSTRIE
IDK6443OtherBLUE CROSS OF IDAHO
ID000010139032OtherREGENCE BLUE SHIELD OF ID
WA8387326Medicaid
ID000010139032OtherREGENCE BLUE SHIELD OF ID
P40463Medicare UPIN