Provider Demographics
NPI:1700970720
Name:EHS KIDNEY CARE OF SPOKANE LLC
Entity Type:Organization
Organization Name:EHS KIDNEY CARE OF SPOKANE LLC
Other - Org Name:EHS KIDNEY CARE SPOKANE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-473-7731
Mailing Address - Street 1:801 W 5TH AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-473-3790
Mailing Address - Fax:509-473-3793
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-473-3790
Practice Address - Fax:509-473-3793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPIRE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039951207RN0300X
WAMD00041214207RN0300X
WAMD00033309207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7106933Medicaid
WA7106933Medicaid
WA8856507Medicare ID - Type Unspecified