Provider Demographics
NPI:1598118523
Name:JOHN T BELKNAP
Entity Type:Organization
Organization Name:JOHN T BELKNAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PUHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-927-5909
Mailing Address - Street 1:9717 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3620
Mailing Address - Country:US
Mailing Address - Phone:509-927-5909
Mailing Address - Fax:509-927-3274
Practice Address - Street 1:9717 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3620
Practice Address - Country:US
Practice Address - Phone:509-927-5909
Practice Address - Fax:509-927-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006246261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014795Medicaid