Provider Demographics
| NPI: | 1417953787 |
|---|---|
| Name: | ROCKWOOD CLINIC PS |
| Entity Type: | Organization |
| Organization Name: | ROCKWOOD CLINIC PS |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHRISTOPHER |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MCGOLDRICK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 509-342-3709 |
| Mailing Address - Street 1: | PO BOX 3649 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SPOKANE |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 99220-3649 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 509-838-2531 |
| Mailing Address - Fax: | 509-455-5315 |
| Practice Address - Street 1: | 400 E 5TH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | SPOKANE |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 99202-1334 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 509-838-2531 |
| Practice Address - Fax: | 509-455-5315 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-06-22 |
| Last Update Date: | 2022-07-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WA | 1041C0700X, 111N00000X, 133V00000X, 152W00000X, 207Q00000X, 207R00000X, 207W00000X, 2084N0400X, 213ES0103X, 225100000X, 225X00000X, 363A00000X, 363L00000X | |
| 2085R0001X, 225700000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ID | 8064900200 | Medicaid | |
| WA | 7075310 | Medicaid | |
| ID | 003284100 | Medicaid | |
| WA | 2120004 | Medicaid | |
| MT | 407472 | Medicaid | |
| ID | 807640100 | Medicaid | |
| WA | 7014012 | Medicaid | |
| WA | 2120004 | Medicaid | |
| WA | 7075310 | Medicaid |
