Provider Demographics
NPI:1437284841
Name:SPOKANE INTERNAL MEDICINE, P.S.
Entity Type:Organization
Organization Name:SPOKANE INTERNAL MEDICINE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-922-8203
Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1048
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-921-0017
Practice Address - Street 1:1215 N MCDONALD RD
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1048
Practice Address - Country:US
Practice Address - Phone:509-924-1950
Practice Address - Fax:509-921-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600 228 682207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7052905Medicaid
WA7052905Medicaid
WAC46641Medicare PIN