Provider Demographics
NPI:1780714139
Name:PLASTIC SURGERY NORTHWEST PLLC
Entity type:Organization
Organization Name:PLASTIC SURGERY NORTHWEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-321-4110
Mailing Address - Street 1:530 S COWLEY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1316
Mailing Address - Country:US
Mailing Address - Phone:509-838-7028
Mailing Address - Fax:509-623-2177
Practice Address - Street 1:530 S COWLEY ST
Practice Address - Street 2:STE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1316
Practice Address - Country:US
Practice Address - Phone:509-838-7028
Practice Address - Fax:509-623-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00032173208200000X
WA00027337208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7139520Medicaid
WA8868754Medicare PIN