Provider Demographics
NPI:1679942619
Name:PSYCHIATRIC CLINIC OF SPOKANE PS
Entity Type:Organization
Organization Name:PSYCHIATRIC CLINIC OF SPOKANE PS
Other - Org Name:DAVID BOT, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-999-5430
Mailing Address - Street 1:201 W NORTH RIVER DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W NORTH RIVER DR
Practice Address - Street 2:STE 520
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2284
Practice Address - Country:US
Practice Address - Phone:509-999-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1077775Medicaid
WAG000304612OtherMEDICARE PTAN
WAA07099Medicare UPIN