Basic Information
| Provider Information | |||||||||
| NPI: | 1710047493 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PULMONARY SPECIALISTS, PS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPOKANE RESPIRATORY CONSULTANTS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 W. 5TH AVE. | ||||||||
| Address2: | SUITE 400W. | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992044800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093533960 | ||||||||
| FaxNumber: | 5096257387 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 W. 5TH AVE. | ||||||||
| Address2: | SUITE 400W. | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992044800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093533960 | ||||||||
| FaxNumber: | 5096257387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | GREG | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5093533950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OP00001169 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | OP00001169 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | OP00001169 | WA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.