Provider Demographics
NPI:1982807731
Name:SPINAL DIAGNOSTICS PLLC
Entity Type:Organization
Organization Name:SPINAL DIAGNOSTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-455-6736
Mailing Address - Street 1:528 E SPOKANE FALLS BLVD
Mailing Address - Street 2:#14
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1638
Mailing Address - Country:US
Mailing Address - Phone:509-455-6736
Mailing Address - Fax:509-455-6737
Practice Address - Street 1:528 E SPOKANE FALLS BLVD
Practice Address - Street 2:#14
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1638
Practice Address - Country:US
Practice Address - Phone:509-455-6736
Practice Address - Fax:509-455-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7200140Medicaid
WAG8856410Medicare ID - Type Unspecified
WA5931720001Medicare NSC
WA7200140Medicaid