Basic Information
| Provider Information | |||||||||
| NPI: | 1922479088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMISON FAMILY MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9631 N NEVADA ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093192430 | ||||||||
| FaxNumber: | 8775682402 | ||||||||
| Practice Location | |||||||||
| Address1: | 9631 N NEVADA ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093192430 | ||||||||
| FaxNumber: | 8775682402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | CONRAD | ||||||||
| AuthorizedOfficialFirstName: | NATALIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5093192430 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OP00001523 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2050216 | 05 | WA | MEDICAID |