Provider Demographics
NPI:1750521720
Name:SPOKANE VALLEY EAR NOSE & THROAT PS
Entity type:Organization
Organization Name:SPOKANE VALLEY EAR NOSE & THROAT PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/TRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:GARRISON
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-928-7272
Mailing Address - Street 1:1424 N MCDONALD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-6017
Mailing Address - Country:US
Mailing Address - Phone:509-928-7272
Mailing Address - Fax:509-928-7346
Practice Address - Street 1:1424 N. MCDONALD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-928-7272
Practice Address - Fax:509-928-7346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOKANE VALLEY EAR NOSE & THROAT PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAASF.FS.60129513261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0257384OtherL&I
WA1010221Medicaid
WA1010221Medicaid