Provider Demographics
NPI:1821206244
Name:SACRED HEART MEDICAL CENTER
Entity Type:Organization
Organization Name:SACRED HEART MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-474-3040
Mailing Address - Street 1:PO BOX 3410
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3410
Mailing Address - Country:US
Mailing Address - Phone:800-752-8994
Mailing Address - Fax:509-474-4925
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-3040
Practice Address - Fax:509-474-4925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-162291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7026727Medicaid
WA7026727Medicaid