Provider Demographics
NPI:1477750651
Name:COLVILLE HEALING ARTS CENTER PSC
Entity Type:Organization
Organization Name:COLVILLE HEALING ARTS CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:MARSH
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-685-2300
Mailing Address - Street 1:150 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2834
Mailing Address - Country:US
Mailing Address - Phone:509-685-2300
Mailing Address - Fax:509-685-0358
Practice Address - Street 1:150 S ELM ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2834
Practice Address - Country:US
Practice Address - Phone:509-685-2300
Practice Address - Fax:509-685-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA07678Medicare UPIN