Provider Demographics
NPI:1154414761
Name:COLUMBIA MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:COLUMBIA MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-688-6700
Mailing Address - Street 1:PO BOX 2808
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2808
Mailing Address - Country:US
Mailing Address - Phone:509-688-6700
Mailing Address - Fax:509-688-6777
Practice Address - Street 1:1003 E TRENT
Practice Address - Street 2:SUITE 150
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-688-6700
Practice Address - Fax:509-688-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 2085R0202X
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8802597Medicare PIN
WAG8802609Medicare PIN
WAG8802617Medicare PIN
WAG8802599Medicare PIN
WAG8807949Medicare PIN
WAG8802603Medicare PIN
WAG8802621Medicare PIN
WAG8802623Medicare PIN
WAG8802607Medicare PIN
WAG8802605Medicare PIN
WAG8802621Medicare PIN