Provider Demographics
NPI:1124136692
Name:NORTH SPOKANE PULMONARY CLINIC, P.S.
Entity type:Organization
Organization Name:NORTH SPOKANE PULMONARY CLINIC, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-465-3919
Mailing Address - Street 1:212 E CENTRAL AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6291
Mailing Address - Country:US
Mailing Address - Phone:509-465-3919
Mailing Address - Fax:509-468-0705
Practice Address - Street 1:212 E CENTRAL AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6291
Practice Address - Country:US
Practice Address - Phone:509-465-3919
Practice Address - Fax:509-468-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027318207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7088974Medicaid
WA7088974Medicaid
WAG8802026Medicare PIN