Provider Demographics
NPI:1396785911
Name:INFECTIOUS DISEASE CLINIC OF SPOKANE
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CLINIC OF SPOKANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-926-1770
Mailing Address - Street 1:21980 E COUNTRY VISTA DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6025
Mailing Address - Country:US
Mailing Address - Phone:509-926-1770
Mailing Address - Fax:509-228-9542
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:#200 WEST
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-353-3960
Practice Address - Fax:509-343-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11697Medicare PIN