Provider Demographics
NPI:1013989532
Name:SURGICAL SPECIALISTS OF SPOKANE
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF SPOKANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-747-6194
Mailing Address - Street 1:910 W 5TH AVE
Mailing Address - Street 2:STE 550
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-252-2830
Mailing Address - Fax:509-252-2841
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE 7060
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2327
Practice Address - Country:US
Practice Address - Phone:509-747-6194
Practice Address - Fax:509-838-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0189191OtherDEPT LABOR & INDUSTRIES
DC4138OtherRAILROAD MEDICARE
WA7125149Medicaid
WA7125149Medicaid