Provider Demographics
NPI:1245430511
Name:MAPLE CLINIC, P. S.
Entity Type:Organization
Organization Name:MAPLE CLINIC, P. S.
Other - Org Name:JEFF MAPLE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-850-2917
Mailing Address - Street 1:7731 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9648
Mailing Address - Country:US
Mailing Address - Phone:509-850-2917
Mailing Address - Fax:
Practice Address - Street 1:7731 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-9648
Practice Address - Country:US
Practice Address - Phone:509-850-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75391Medicare UPIN