Basic Information
| Provider Information | |||||||||
| NPI: | 1891805214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITMAN ANESTHESIA PS | ||||||||
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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: | 1200 W FAIRVIEW ST | ||||||||
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| City: | COLFAX | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991119552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093973435 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5099261770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 9633082 | 05 | WA | MEDICAID |