Provider Demographics
NPI:1255381109
Name:COLETTI, ANDREW THOMAS (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:COLETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0331
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:122 W 7TH AVE STE 232
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-838-4978
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-12142207RA0001X
WAMD00043943207RA0001X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2547COOtherREGNECE BLUE SHIELD
WA8402372Medicaid
WAA058OtherTRI WEST (TRICARE)
AKMD6425Medicaid
WA0279971OtherL&I AND CRIME VICTIMS FOR PHMG
WA5793737OtherAETNA
WA1255381109Medicaid
WA82107OtherL&I AND CRIME VICTIMS FOR SJMC
WAG8900988 FOR PHMGMedicare PIN
WA0279971OtherL&I AND CRIME VICTIMS FOR PHMG
WA82107OtherL&I AND CRIME VICTIMS FOR SJMC
WAG8878798 FOR SJMCMedicare PIN
WAG8804963Medicare PIN