Basic Information
| Provider Information | |||||||||
| NPI: | 1326351297 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROVIDENCE HEALTH & SERVICES | ||||||||
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| OtherOrganizationName: | PROVIDENCE SPOKANE HEART INSTITUTE-NORTHWEST WASHINGTON MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3776 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255256798 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 GARDEN HOMES DR | ||||||||
| Address2: | |||||||||
| City: | COLVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991149229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096843701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2010 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNCAN | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR OF REVENUE CYCLE MGT. | ||||||||
| AuthorizedOfficialTelephone: | 4252545362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.