Provider Demographics
NPI:1275720724
Name:JAMES C BONVALLET MD PS
Entity Type:Organization
Organization Name:JAMES C BONVALLET MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THORAACIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:BONVALLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-489-7866
Mailing Address - Street 1:220 E ROWAN AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1202
Mailing Address - Country:US
Mailing Address - Phone:509-489-7866
Mailing Address - Fax:509-489-7762
Practice Address - Street 1:220 E ROWAN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1202
Practice Address - Country:US
Practice Address - Phone:509-489-7866
Practice Address - Fax:509-489-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7836901Medicaid
WA7836901Medicaid