Provider Demographics
NPI:1588857924
Name:SPOKANE CLINIC FOR RECTAL AND COLON DISEASE, PS
Entity type:Organization
Organization Name:SPOKANE CLINIC FOR RECTAL AND COLON DISEASE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C S
Authorized Official - Last Name:COLQUHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-448-2278
Mailing Address - Street 1:5515 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1628
Mailing Address - Country:US
Mailing Address - Phone:509-448-2278
Mailing Address - Fax:
Practice Address - Street 1:5515 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1628
Practice Address - Country:US
Practice Address - Phone:509-448-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600108525261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7835002Medicaid
WA7835002Medicaid