Provider Demographics
NPI:1861506289
Name:SPOKANE VALLEY EAR, NOSE &THROAT, P.S.
Entity Type:Organization
Organization Name:SPOKANE VALLEY EAR, NOSE &THROAT, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-928-7272
Mailing Address - Street 1:1424 N. MCDONALD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1088
Mailing Address - Country:US
Mailing Address - Phone:509-928-7272
Mailing Address - Fax:509-928-7346
Practice Address - Street 1:1424 N MCDONALD RD STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-6017
Practice Address - Country:US
Practice Address - Phone:509-928-7272
Practice Address - Fax:509-928-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA59650OtherLABOR & INDUSTRIES
MT8853507Medicaid
WA8919358OtherCRIME VICTIMS PROVIDER #
ID003230800Medicaid
WA7154909Medicaid
WA59650OtherLABOR & INDUSTRIES
ID003230800Medicaid