Provider Demographics
NPI:1336186105
Name:PHYSICIANS CLINIC OF SPOKANE PS
Entity Type:Organization
Organization Name:PHYSICIANS CLINIC OF SPOKANE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-747-1144
Mailing Address - Street 1:820 S MCCLELLAN
Mailing Address - Street 2:#LL10
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-353-3973
Mailing Address - Fax:509-838-8275
Practice Address - Street 1:820 S MCCLELLAN
Practice Address - Street 2:#LL10
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-353-3973
Practice Address - Fax:509-838-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL0620049261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7202609Medicaid
WA00606OtherL & I
WA7202609Medicaid