Provider Demographics
NPI:1275704181
Name:PHYSICIANS ANESTHESIA GROUP, PS
Entity Type:Organization
Organization Name:PHYSICIANS ANESTHESIA GROUP, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATE
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-838-8561
Mailing Address - Street 1:104 W 5TH AVE STE 230E
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4808
Mailing Address - Country:US
Mailing Address - Phone:509-838-8561
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:104 W 5TH AVE STE 230E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4808
Practice Address - Country:US
Practice Address - Phone:509-838-8561
Practice Address - Fax:509-835-4058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSIAINS ANESTHESIA GROUP, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7847700Medicaid
WA8667Medicare PIN