Provider Demographics
NPI:1477934578
Name:MT. SPOKANE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:MT. SPOKANE PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-270-0065
Mailing Address - Street 1:759 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-270-0065
Mailing Address - Fax:509-319-2520
Practice Address - Street 1:759 E HOLLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-270-0065
Practice Address - Fax:509-319-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760195382OtherNPI
1881434975OtherNPI
WAAP61351087OtherARNP
1023617347OtherNPI
1306689278OtherNPI
1477189785OtherNPI
WA1477934578OtherNPI
WA1609330992OtherNPI
WAAP60929537OtherARNP
WAAP61335304OtherARNP
WASI61064749OtherSLP
WA1447988530OtherNPI
WAAP60228997OtherARNP
WAAP60327358OtherARNP
WAOT60064658OtherOT
1366298085OtherNPI
WAAP60942013OtherARNP
WAAP61315755OtherARNP
WAAP60919324OtherARNP
WAAP61109016OtherARNP
WAOT60869302OtherOT
1083329072OtherNPI
WA1376830299OtherNPI
1811779002OtherNPI
WAAP61091392OtherARNP
WAAP61224996OtherARNP
WAAP61338441OtherARNP
WA1588902597OtherNPI
WAPT60630044OtherPT
1033980628OtherNPI
1245962232OtherNPI
WAAP60864435OtherARNP
WAAP60864435OtherARNP
WAAP61091392OtherARNP
WAAP61109016OtherARNP