Provider Demographics
NPI:1902859598
Name:SPOKANE VALLEY FAMILY MEDICINE P.S.
Entity Type:Organization
Organization Name:SPOKANE VALLEY FAMILY MEDICINE P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANDSCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-928-0300
Mailing Address - Street 1:13102 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2710
Mailing Address - Country:US
Mailing Address - Phone:509-928-0300
Mailing Address - Fax:509-922-9241
Practice Address - Street 1:13102 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2710
Practice Address - Country:US
Practice Address - Phone:509-928-0300
Practice Address - Fax:509-922-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601 358 148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000371160Medicare ID - Type Unspecified