Provider Demographics
NPI:1841438157
Name:AMY ECHELBERGER PLLC
Entity type:Organization
Organization Name:AMY ECHELBERGER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-852-1024
Mailing Address - Street 1:406 E ROWAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1201
Mailing Address - Country:US
Mailing Address - Phone:509-489-4040
Mailing Address - Fax:509-489-9190
Practice Address - Street 1:406 E. ROWAN AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-3473
Practice Address - Country:US
Practice Address - Phone:509-489-4040
Practice Address - Fax:509-489-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00734032OtherRAILROAD MEDICARE
WAG8882029OtherMEDICARE CORPORATON
WAG8882028OtherMEDICARE INDIVIDUAL