Provider Demographics
NPI:1760641021
Name:SPOKANE HYPERBARIC AND WOUND CARE CONSULTANTS PS
Entity Type:Organization
Organization Name:SPOKANE HYPERBARIC AND WOUND CARE CONSULTANTS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-473-7005
Mailing Address - Street 1:452 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1943
Mailing Address - Country:US
Mailing Address - Phone:509-747-9039
Mailing Address - Fax:509-473-2893
Practice Address - Street 1:WEST 800 FIFTH AVE
Practice Address - Street 2:DEACONESS MEDICAL CENTER
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99210
Practice Address - Country:US
Practice Address - Phone:509-473-7005
Practice Address - Fax:509-473-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20992208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808151700Medicaid
WA7143936Medicaid
WAG8875793Medicare PIN