PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1629395397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629395397 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Other Organization Name | PPS GENETICS |
| Practice Address |
105 W 8th Ave 454 E Spokane WA 99204-2302 |
| Mailing Address |
101 W 8th Ave Mother Gamelin Center, 3rd Floor Spokane WA 99204-2307 |
| Practice Telephone | 5094743810 |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2011-09-16 |
| Authorized Official Name | ANSELMO NUNEZ (CHIEF EXECUTIVE) |
| Authorized Official Telephone | 5094746616 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PPS GENETICS | 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 |
105 W 8TH AVE 454 E |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204-2302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972506814 | Jennifer Kay Pary | Psychiatry & Neurology | 105 W 8th Ave, Suite 318c, Spokane, WA 99204-2302 | 2005-05-24 |
| 1285191346 | Lauren A Earthman | Physician Assistant | 105 W 8th Ave, Spokane, WA 99204-2302 | 2019-02-25 |
| 1285104885 | Jonathan Carmen Panetta | Nurse Practitioner | 105 W 8th Ave, Spokane, WA 99204-2302 | 2018-11-27 |
| 1821516949 | Hayden Ingram | Pharmacist | 105 W 8th Ave, Spokane, WA 99204-2302 | 2017-09-08 |
| 1326573031 | Charlotte Lynch | Advanced Practice Midwife | 105 W 8th Ave, Suite 6020, Spokane, WA 99204-2302 | 2017-05-01 |
| 1336698703 | Jocelyn Diana Christianson | Counselor | 105 W 8th Ave, Suite 332, Spokane, WA 99204-2302 | 2016-09-27 |
| 1972057172 | Ashlee Nicole Bradshaw | Counselor | 105 W 8th Ave, Suite 332, Spokane, WA 99204-2302 | 2016-08-05 |
| 1720439045 | Kristin Martin | Nurse Practitioner | 105 W 8th Ave, Suite 200, Spokane, WA 99204-2302 | 2016-06-28 |
| 1871940809 | Elizabeth Killian | Counselor | 105 W 8th Ave, Ste.332, Spokane, WA 99204-2302 | 2016-05-19 |
| 1962860981 | Mahshid Aghasadeghi | Registered Nurse | 105 W 8th Ave, Suite 6020, Spokane, WA 99204-2302 | 2016-02-04 |
| 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 | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629267067 | Sarah L. Dugan | Medical Genetics | 105 W 8th Ave Ste 454e, Spokane, WA 99204-2318 | 2007-10-22 |
| 1104804442 | Judith Martin | Medical Genetics | 105 W 8th Ave, Suite 454e, Spokane, WA 99204-2302 | 2006-01-06 |
| 1174507073 | Samuel P. Yang | Medical Genetics | 105 W 8th Ave, Suite 454e, Spokane, WA 99204-2302 | 2005-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316196124 | Ghayda Mirzaa | Medical Genetics | 1900 9th Ave, Mailstop C9s-10, Seattle, WA 98101-1309 | 2008-09-17 |
| 1164632170 | Mitzi L Murray | Medical Genetics | 3905 Rockridge Pkwy, Anacortes, WA 98221-4515 | 2007-05-22 |
| 1174600183 | Kristine Michelle King | Medical Genetics | 4033 Talbot Rd S Ste 470, Renton, WA 98055-5700 | 2006-11-01 |
| 1871689273 | Nancy Louise Fisher | Medical Genetics | 676 Woodland Sq Loop Se, Ms 42701, Olympia, WA 98504-2701 | 2006-10-04 |
| 1184636227 | Melissa Ann Parisi | Medical Genetics | 4800 Sand Point Way Ne # M2-9, Children's Hospital and Regional Medical Center, Seattle, WA 98105-3901 | 2006-08-13 |
| 1922064088 | Holly Hutchison Ardinger | Medical Genetics | 12404 Kallgren Rd Ne, Bainbridge Island, WA 98110-3328 | 2006-04-25 |
| 1164412813 | Amy Lawson Yuen | Medical Genetics | 311 S L St, Tacoma, WA 98405-3720 | 2005-10-25 |
| 1053806711 | Yakima Valley Memorial Hospital | Medical Genetics | 3801 Kern Road, Yakima, WA 98902 | 2018-06-26 |
| 1275945081 | Jessica Ogawa | Medical Genetics | 311 S L St, Tacoma, WA 98405-3720 | 2014-05-28 |
| 1033539671 | Irene Joan Chang | Medical Genetics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2014-04-22 |
| Find all providers with the same taxonomy | ||||
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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.