Provider Demographics
NPI:1073810222
Name:CHAMPIONS SPORTS MEDICINE
Entity Type:Organization
Organization Name:CHAMPIONS SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:Z
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:509-891-1291
Mailing Address - Street 1:730 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2045
Mailing Address - Country:US
Mailing Address - Phone:509-487-4467
Mailing Address - Fax:509-487-4503
Practice Address - Street 1:730 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2045
Practice Address - Country:US
Practice Address - Phone:509-487-4467
Practice Address - Fax:509-487-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019290208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty