Provider Demographics
NPI:1184756793
Name:SPOKANE OBSTETRICS & GYNECOLOGY, PS
Entity type:Organization
Organization Name:SPOKANE OBSTETRICS & GYNECOLOGY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-838-4211
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 6060
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-838-4211
Mailing Address - Fax:509-838-6432
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 6060
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-4211
Practice Address - Fax:509-838-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7764608Medicaid
WA000358300Medicare ID - Type UnspecifiedCLINIC NUMBER