PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1356646202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356646202 |
Entity Type | Organization |
Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
Other Organization Name | PROVIDENCE INLAND VASCULAR INSTITUTE |
Practice Address |
122 W 7th Ave Ste 420 Spokane WA 99204-2349 |
Mailing Address |
101 W 8th Ave Mother Gamelin Center, 3rd Floor Spokane WA 99204-2307 |
Practice Telephone | 5098388286 |
Enumeration Date | 2011-01-24 |
Last Update Date | 2011-03-24 |
Authorized Official Name | ANSELMO NUNEZ (CHIEF EXECUTIVE) |
Authorized Official Telephone | 5094746616 |
Authorized Official Credential | CE |
Is Organization Subpart | Y |
Parent Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
600503827 | WA | Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Providence Inland Vascular Institute | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740566173 | Providence Physician Services Co | Internal Medicine | 212 Central Ave Suite 440, Spokane, WA 99208 | 2011-10-31 |
1295016145 | Providence Physician Services Co | Family Medicine | 801 W. 5th Ave, Suite 307, Spokane, WA 99204 | 2011-09-06 |
1619268281 | Providence Physician Services Co | Family Medicine | 100 W. South Ave Chewelah, Chewelah, WA 99109 | 2011-04-29 |
1184915829 | Providence Physician Services Co | Family Medicine | 5011 W. Lowell Ave, Seattle, WA 99208-8587 | 2011-04-28 |
1578869913 | Providence Physician Services Co | Family Medicine | 12704 E Nora Ave, Ste B, Spokane Valley, WA 99216-1140 | 2011-02-02 |
1891001277 | Providence Physician Services Co | Pediatrics | 5901 N Linderwood, Suite 126, Spokane, WA 99207 | 2010-08-24 |
1245557917 | Providence Physician Services Co | Obstetrics & Gynecology | 518 Clay Street, Chewelah, WA 99109 | 2010-04-21 |
1215223953 | Providence Physician Services Co | Prosthetic/Orthotic Supplier | 101 W 8th Ave, Mother Gamelin Center, 3rd Floor, Spokane, WA 99204-2307 | 2011-06-21 |
1336433812 | Providence Physician Services Co | Family Medicine | 104 W 5th Ave, Suite 390e, Spokane, WA 99204 | 2011-06-02 |
1053618892 | Providence Physician Services Co | Internal Medicine | 105 W 8th Ave, Ste 550e, Spokane, WA 99204-2302 | 2011-02-14 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Washington State Corporations | PROVIDENCE PHYSICIAN SERVICES CO. | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
Street Address |
122 W 7TH AVE STE 420 |
City | SPOKANE |
State | WA |
Zip Code | 99204-2349 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720081979 | Karen L Wollenberg | Registered Nurse | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2005-05-23 |
1508484395 | Alia Emilie Soulek | Nurse Practitioner | 122 W 7th Ave, Spokane, WA 99204-2349 | 2020-07-08 |
1194239707 | Carrie Joann Estuar | Nurse Practitioner | 122 W 7th Ave, Spokane, WA 99204-2349 | 2017-11-20 |
1942736731 | Jessica Keen | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2017-05-11 |
1457887937 | Jeremiah Mckee | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2017-05-03 |
1003222845 | Kristin Walters | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2014-07-01 |
1851669337 | Dacia Kay Murillo | Physician Assistant | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2011-12-12 |
1144538158 | Ryan Forsyth | Physician Assistant | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2010-09-24 |
1043524481 | Luke Xiaoli Zhan | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2010-07-27 |
1801114129 | Inland Cardiology Associates Ps | Physician Assistant | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2332 | 2010-05-11 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982250957 | Megan Elizabeth Dibenedetto | Pharmacist | 105 West 8th Avenue, 350e, Spokane, WA 99204 | 2019-08-14 |
1619521168 | Evelyn R Cabon | Genetic Counselor, MS | 101 W. 8th Avenue Suite 1100, Spokane, WA 99204 | 2019-08-01 |
1346700655 | Christina Rose | Student in an Organized Health Care Education/Training Program | 120 W. 8th Avenue, Spokane, WA 99204 | 2019-03-22 |
1508339862 | Cody J French | Physical Therapist | Washington Outpatient Rehab, 507 S Washington, Spokane, WA 99204 | 2019-01-09 |
1730655598 | Washington Outpatient Rehabilitation, LLC | Physical Therapist | 507 S. Washington St., Suite 10, Spokane, WA 99204 | 2018-10-19 |
1013405547 | Joel James Hayden | Student in an Organized Health Care Education/Training Program | Providence Sacred Heart, 101 West 8th Avenue, Spokane, WA 99204 | 2018-04-30 |
1144694787 | Brooksjohnsonpllc | Dentist | 1004 S. Monroe Street, Ste 100, Spokane, WA 99204 | 2015-11-19 |
1497184196 | Kathalene M Cassels | Physician Assistant | 810 W. 5th Ave. Ste 510, Spokane, WA 99204 | 2013-11-04 |
1174880454 | Kelly E Wurzel | Psychiatry & Neurology | 624 E. Front Ave, Spokane, WA 99204 | 2012-04-11 |
1003190331 | Katie L Gomez | Nurse Practitioner | 805 W. 5th Ave, Suite 518, Spokane, WA 99204 | 2011-10-05 |
Find all providers in zip 99204 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508841966 | Stephens Davis Taylor | Surgery | 910 W 5th Ave Ste 900, Spokane, WA 99204-2948 | 2005-12-08 |
1043524481 | Luke Xiaoli Zhan | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2010-07-27 |
1285952085 | Lindsay Michelle Gates | Surgery | 910 W 5th Ave, Suite 900, Spokane, WA 99204-2966 | 2010-05-04 |
1235273632 | Beejay Feliciano | Surgery | 910 W 5th Ave Ste 900, Spokane, WA 99204-2948 | 2007-02-18 |
1669482154 | Adnan Z Rizvi | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2006-08-08 |
1104874569 | Ryan D. Nachreiner | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2006-05-05 |
1770547572 | Hassan Y. Tehrani | Surgery | 910 W 5th Ave, Suite 1000, Spokane, WA 99204-2966 | 2006-04-17 |
1154385847 | Mary Kathleen Reilly | Surgery | 122 W 7th Ave, 410 & 420, Spokane, WA 99204-2349 | 2006-04-12 |
1427011394 | Stephen P Murray | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2006-04-10 |
1659334936 | Joseph Anton Davis | Surgery | 122 W 7th Ave, 420, Spokane, WA 99204-2349 | 2006-04-08 |
Find all providers in SPOKANE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.