Provider Demographics
NPI:1134127657
Name:INLAND NORTHWEST SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:INLAND NORTHWEST SURGERY CENTER PLLC
Other - Org Name:FAMILY FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THOMASIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-924-2600
Mailing Address - Street 1:526 N MULLAN RD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-2407
Mailing Address - Country:US
Mailing Address - Phone:509-924-2600
Mailing Address - Fax:509-926-9865
Practice Address - Street 1:526 N MULLAN RD
Practice Address - Street 2:SUITE A & B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-2407
Practice Address - Country:US
Practice Address - Phone:509-924-2600
Practice Address - Fax:509-926-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000333213E00000X
WAP000000388213E00000X
WAP000000698213E00000X
WA6011706837261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127533Medicaid
WA0143764OtherLABOR INDUSTRIES
WADD3019OtherRAIL ROAD MEDICARE
WA4291150001Medicare NSC
WADD3019OtherRAIL ROAD MEDICARE