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?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1447988530OtherNPI
WA1477934578OtherNPI
WA1609330992OtherNPI
WA1154959484OtherSLP
WA1588902597OtherNPI
WAAP61109016OtherARNP
WAAP61351087OtherARNP
WA1043822372OtherNPI
WA1831681683OtherNPI
WA1851870745OtherNPI
WA1861939910OtherNPI
WAAP60864435OtherARNP
WAOT60064658OtherOT
WA1083366991OtherNPI
WA1851024582OtherNPI
WAAP60228997OtherARNP
WA1578875076OtherNPI
WAAP60327358OtherARNP
WAAP61224996OtherARNP
WAOT60869302OtherOT
WA1205394335OtherNPI
WA1336412311OtherOT
WA1942935069OtherNPI
WAAP61338441OtherARNP
WAPT60630044OtherPT
WA1588264287OtherNPI
WA1972142685OtherNPI
WAAP60929537OtherARNP
WAAP61091392OtherARNP
WAAP61335304OtherARNP
WA1376830299OtherNPI
WAAP60919324OtherARNP
WAAP60942013OtherARNP
WAAP61315755OtherARNP
WASI61064749OtherSLP