Basic Information
| Provider Information | |||||||||
| NPI: | 1396785911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASE CLINIC OF SPOKANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21980 E COUNTRY VISTA DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990196025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099261770 | ||||||||
| FaxNumber: | 5092289542 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 W 5TH AVE | ||||||||
| Address2: | #200 WEST | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992044880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093533960 | ||||||||
| FaxNumber: | 5093430134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | GOTT | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5099261770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.