Provider Demographics
NPI:1588797807
Name:SPOKANE DIGESTIVE DISEASE CENTER, P.S.
Entity Type:Organization
Organization Name:SPOKANE DIGESTIVE DISEASE CENTER, P.S.
Other - Org Name:SOUTH ASC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-838-5950
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 6010
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-838-5950
Mailing Address - Fax:509-838-5961
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 6010
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-5950
Practice Address - Fax:509-838-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00055904261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA07875Medicare UPIN
WAH82361Medicare UPIN
WAE32647Medicare UPIN
WAA07877Medicare UPIN
WAE93230Medicare UPIN
WAS06387Medicare UPIN
WAA07517Medicare UPIN