Provider Demographics
NPI:1578562815
Name:VAIL, TORREY A (PA-C)
Entity Type:Individual
Prefix:
First Name:TORREY
Middle Name:A
Last Name:VAIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-456-0262
Mailing Address - Fax:509-462-5059
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:STE 110
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-456-0262
Practice Address - Fax:509-462-5059
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003341363AS0400X
IDPA-457363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1665079OtherMEDICARE PTAN
WAG8878132OtherMEDICARE PTAN
WA8374779Medicaid
ID804123100Medicaid
WAG8871065OtherMEDICARE PTAN
WAG8878132OtherMEDICARE PTAN
ID1665372Medicare PIN
S23105Medicare UPIN