Provider Demographics
NPI:1851391783
Name:INLAND EMPIRE GASTROENTEROLOGY PS
Entity Type:Organization
Organization Name:INLAND EMPIRE GASTROENTEROLOGY PS
Other - Org Name:INLAND EMPIRE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:FITTERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-747-0143
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 6050
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-747-0143
Mailing Address - Fax:509-744-1571
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 6050
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-747-0143
Practice Address - Fax:509-744-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089873Medicaid
WAGAB03685Medicare PIN