Provider Demographics
NPI:1568612935
Name:WA-SPOK PULMONARY & CRITICAL CARE LLC
Entity Type:Organization
Organization Name:WA-SPOK PULMONARY & CRITICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:910 W 5TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2967
Mailing Address - Country:US
Mailing Address - Phone:509-625-1915
Mailing Address - Fax:509-625-1919
Practice Address - Street 1:910 W 5TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2967
Practice Address - Country:US
Practice Address - Phone:509-625-1915
Practice Address - Fax:509-625-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8876444Medicare UPIN