Provider Demographics
NPI:1326147224
Name:SACRED HEART MEDICAL CENTER
Entity Type:Organization
Organization Name:SACRED HEART MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYLAND
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-474-3040
Mailing Address - Street 1:PO BOX 2555
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-162282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG00611OtherREG BLSH OF ID
CAXHSP31535Medicaid
WA3304201Medicaid
CAXHSP41535Medicaid
OR05131-8Medicaid
WA15OtherPREMERA
WA20OtherGROUP HEALTH
WA8901066OtherL&I VOC
WA2986OtherL&I WA
IDK0289OtherSPHCO BC OF IDAHO
WASA1389OtherASURIS INPT
WA15OtherBLUE CROSS/BLUE SHIELD
MT418366Medicaid
MT418366Medicaid
WA3304201Medicaid
CAXHSP41535Medicaid