Provider Demographics
NPI:1346223039
Name:A CENTER FOR HEALTH AND WELLNESS P
Entity Type:Organization
Organization Name:A CENTER FOR HEALTH AND WELLNESS P
Other - Org Name:A CENTER FOR HEALTH AND WELLNESS P
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-456-2406
Mailing Address - Street 1:PO BOX 9819
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-9819
Mailing Address - Country:US
Mailing Address - Phone:509-456-2406
Mailing Address - Fax:509-456-2407
Practice Address - Street 1:521 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2511
Practice Address - Country:US
Practice Address - Phone:509-456-2406
Practice Address - Fax:509-456-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117225Medicaid
WA0181497OtherL & I
WA0181497OtherL & I
WAG8808869Medicare PIN