Provider Demographics
NPI:1023253374
Name:BOURGET HEALTH SERVICES INC
Entity type:Organization
Organization Name:BOURGET HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFP
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-755-8903
Mailing Address - Street 1:PO BOX 2687
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2687
Mailing Address - Country:US
Mailing Address - Phone:509-755-8600
Mailing Address - Fax:509-755-8319
Practice Address - Street 1:110 W CLIFF DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3638
Practice Address - Country:US
Practice Address - Phone:509-755-8600
Practice Address - Fax:509-755-8319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOURGET HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS-0416291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7010937Medicaid
000301194Medicare Oscar/Certification