Provider Demographics
NPI:1518142652
Name:INLAND NORTHWEST SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:INLAND NORTHWEST SURGERY CENTER PLLC
Other - Org Name:FAMILY FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-924-2600
Mailing Address - Street 1:526 N MULLAN RD
Mailing Address - Street 2:STE B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-2408
Mailing Address - Country:US
Mailing Address - Phone:509-924-2600
Mailing Address - Fax:509-926-9865
Practice Address - Street 1:526 N MULLAN RD
Practice Address - Street 2:STE B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-2408
Practice Address - Country:US
Practice Address - Phone:509-924-2600
Practice Address - Fax:509-926-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4291150001Medicare NSC