Provider Demographics
NPI:1487671194
Name:WASHINGTON STATE UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON STATE UNIVERSITY
Other - Org Name:PEOPLE'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARYL
Authorized Official - Middle Name:'KIM'
Authorized Official - Last Name:CALAMIA-MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-755-7624
Mailing Address - Street 1:829 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2117
Mailing Address - Country:US
Mailing Address - Phone:509-755-7624
Mailing Address - Fax:
Practice Address - Street 1:829 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2117
Practice Address - Country:US
Practice Address - Phone:509-755-7624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9628702Medicaid
WA9628702Medicaid