Provider Demographics
NPI:1538605035
Name:SUSAN C HECKER MD, PLLC
Entity type:Organization
Organization Name:SUSAN C HECKER MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CARNINE
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-699-9870
Mailing Address - Street 1:6912 W MELVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9027
Mailing Address - Country:US
Mailing Address - Phone:208-699-9870
Mailing Address - Fax:
Practice Address - Street 1:9631 N NEVADA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1133
Practice Address - Country:US
Practice Address - Phone:509-489-4040
Practice Address - Fax:509-489-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60237462261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care