WA-SPOK MEDICAL CARE LLC

Provider Demographics

• NPI: 1649420019
• Name: WA-SPOK MEDICAL CARE LLC
• Entity Type: Organization
• Organization Name: WA-SPOK MEDICAL CARE LLC
• Authorized Official - Title/Position: DIRECTOR
• Authorized Official - First Name: DEBBIE
• Authorized Official - Last Name: BREWER
• Authorized Official - Phone: 877-892-9813
• Mailing Address - Street 1: 801 W FIFTH AVE
• Mailing Address - Street 2: SUITE 422
• Mailing Address - City: SPOKANE
• Mailing Address - State: WA
• Mailing Address - Zip Code: 99204-2841
• Mailing Address - Country: US
• Mailing Address - Phone: 509-473-7250
• Mailing Address - Fax: 509-473-3033
• Practice Address - Street 1: 801 W FIFTH AVE
• Practice Address - Street 2: SUITE 422
• Practice Address - City: SPOKANE
• Practice Address - State: WA
• Practice Address - Zip Code: 99204-2841
• Practice Address - Country: US
• Practice Address - Phone: 509-473-7250
• Practice Address - Fax: 509-473-3033
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-09-23
• Last Update Date: 2012-02-01

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	207T00000X	Allopathic & Osteopathic Physicians	Neurological Surgery		Group - Multi-Specialty
No	2084H0002X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Hospice and Palliative Medicine	Group - Multi-Specialty
No	2086S0129X	Allopathic & Osteopathic Physicians	Surgery	Vascular Surgery	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	0242178	Other	DEPT L&I
WA	7144553	Medicaid
WA	0242178	Other	DEPT L&I