Provider Demographics
NPI: | 1477934578 |
---|---|
Name: | MT. SPOKANE PEDIATRICS, PLLC |
Entity Type: | Organization |
Organization Name: | MT. SPOKANE PEDIATRICS, PLLC |
Other - Org Name: | MT. SPOKANE PEDIATRICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICOLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 509-270-0065 |
Mailing Address - Street 1: | 759 E HOLLAND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SPOKANE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99218-1257 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-270-0065 |
Mailing Address - Fax: | 509-319-2520 |
Practice Address - Street 1: | 759 E HOLLAND AVE |
Practice Address - Street 2: | |
Practice Address - City: | SPOKANE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99218-1257 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-270-0065 |
Practice Address - Fax: | 509-319-2520 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-06-15 |
Last Update Date: | 2022-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Single Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Single Specialty |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Single Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Single Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Single Specialty | |
No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | Group - Single Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Single Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Single Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Single Specialty |
No | 363LX0106X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 1447988530 | Other | NPI |
WA | 1477934578 | Other | NPI |
WA | 1609330992 | Other | NPI |
WA | 1154959484 | Other | SLP |
WA | 1588902597 | Other | NPI |
WA | AP61109016 | Other | ARNP |
WA | AP61351087 | Other | ARNP |
WA | 1043822372 | Other | NPI |
WA | 1831681683 | Other | NPI |
WA | 1851870745 | Other | NPI |
WA | 1861939910 | Other | NPI |
WA | AP60864435 | Other | ARNP |
WA | OT60064658 | Other | OT |
WA | 1083366991 | Other | NPI |
WA | 1851024582 | Other | NPI |
WA | AP60228997 | Other | ARNP |
WA | 1578875076 | Other | NPI |
WA | AP60327358 | Other | ARNP |
WA | AP61224996 | Other | ARNP |
WA | OT60869302 | Other | OT |
WA | 1205394335 | Other | NPI |
WA | 1336412311 | Other | OT |
WA | 1942935069 | Other | NPI |
WA | AP61338441 | Other | ARNP |
WA | PT60630044 | Other | PT |
WA | 1588264287 | Other | NPI |
WA | 1972142685 | Other | NPI |
WA | AP60929537 | Other | ARNP |
WA | AP61091392 | Other | ARNP |
WA | AP61335304 | Other | ARNP |
WA | 1376830299 | Other | NPI |
WA | AP60919324 | Other | ARNP |
WA | AP60942013 | Other | ARNP |
WA | AP61315755 | Other | ARNP |
WA | SI61064749 | Other | SLP |