MOUNTAIN WEST DERM - BLACKHART PLLC (NPI# 1013557933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013557933 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Practice Address |
1807 N Hutchinson Rd Spokane Valley WA 99212-2444 |
| Practice Telephone | 5094567414 |
| Practice Fax Number | 5096240763 |
| Mailing Telephone | 5094567414 |
| Mailing Fax Number | 5096240763 |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-01-08 |
| Authorized Official Name | BRET S BLACKHART (OWNER) |
| Authorized Official Telephone | 7753363624 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Advanced Dermatology & Skin Surgery | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1700 W Riverstone Dr, Coeur D Alene, ID 838145683 | 2087702822 | 2087702911 |
| 5905 N Mayfair St Ste 200, Spokane, WA 992081127 | 5094567414 | 5096240764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619517539 | Mountain West Derm - Blackhart Pllc | Clinic/Center | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2020-01-08 |
| 1124670088 | Mountain West Derm - Blackhart Pllc | Dermatology | 3841 Piper St Ste T4-020, Anchorage, AK 99508-4673 | 2019-07-11 |
| 1447764741 | Mountain West Derm - Blackhart Pllc | Dermatology | 2747 Ne Conners Ave, Bend, OR 97701-8738 | 2017-11-22 |
| 1740633015 | Mountain West Derm - Blackhart Pllc | Dermatology | 3950 Gs Richards Blvd, Carson City, NV 89703-8457 | 2016-07-21 |
| Street Address |
1807 N HUTCHINSON RD |
| City | SPOKANE VALLEY |
| State | WA |
| Zip Code | 99212-2444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184699365 | Joel K Sears | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-21 |
| 1619517539 | Mountain West Derm - Blackhart Pllc | Clinic/Center | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2020-01-08 |
| 1477853760 | Thomas M Ryan, Md | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2010-11-02 |
| 1710213558 | Kathleen R Lejameyer | Nurse Practitioner | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2009-10-29 |
| 1467673061 | Chadd Sukut | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2007-05-01 |
| 1154408631 | Elizabeth Joan Jacobsen | Physician Assistant | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-11-01 |
| 1215023007 | Andrea Mead Dominey | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-10-05 |
| 1689636649 | Jeanne M Ellern | Physician Assistant | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-04-05 |
| 1972579845 | Advanced Dermatology and Skin Surgery Pllc | Clinical Medical Laboratory | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-28 |
| 1881660751 | Advanced Dermatology and Skin Surgery, Pllc | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750889580 | Melissa Lerai Lunsford | Massage Therapist | 1212 N Argonne Rd, Spokane Valley, WA 99212 | 2018-01-26 |
| 1225558539 | Paul James Hammerschmidt | Licensed Practical Nurse | 5600 E. 8th Avenue, Spokane Valley, WA 99212 | 2017-06-27 |
| 1497009302 | Ray A Schoessler | Pharmacist | 9009 E Trent Ave, Spokane, WA 99212 | 2012-10-30 |
| 1215205224 | Wchs Inc | Counselor | 4305 East Trent Avenue, Spokane, WA 99212 | 2011-12-05 |
| 1609159466 | Andrey V Altukhov | Specialist | 906 S. Park Rd, Spokane Valley, WA 99212 | 2011-09-27 |
| 1215189808 | Providence Health & Services - Wa | Home Health | 1000 N Argonne Rd, Spokane Valley, WA 99212 | 2008-10-15 |
| 1568674414 | Colleen Kirsten Monroe | Pharmacist | 5601 E Sprague, Spokane, WA 99212 | 2007-05-04 |
| 1205968534 | Jeremiah Michael Stevens | Naturopath | 1510 N Argonne Rd Ste G, Spokane Valley, WA 99212 | 2007-03-12 |
| 1104957547 | Lyudmila Larkin | Specialist | 8120 E. Vista Lane, Spokane, WA 99212 | 2007-03-08 |
| 1972613511 | Costco Wholesale Corporation | Pharmacy | 5601 E Sprague Ave, Spokane Valley, WA 99212 | 2006-08-30 |
| Find all providers in zip 99212 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992803811 | Scott Allen Smith | Dermatology | 12509 E Mission Ave Ste 102, Spokane Valley, WA 99216-1061 | 2006-09-21 |
| 1184699365 | Joel K Sears | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-21 |
| 1477853760 | Thomas M Ryan, Md | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2010-11-02 |
| 1972791226 | Valley Dermatology and Skin Cancer Center | Dermatology | 12509 E Mission Ave Ste 102, Spokane Valley, WA 99216-1061 | 2007-10-11 |
| 1467673061 | Chadd Sukut | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2007-05-01 |
| 1215023007 | Andrea Mead Dominey | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-10-05 |
| 1386619294 | Paul T Dunn | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-22 |
| 1194790006 | Staci M Hestdalen | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-22 |
| 1548235450 | Joseph L Cvancara | Dermatology | 1807 N Hutchinson Rd, Spokane Valley, WA 99212-2444 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629694864 | Fishers Landing Internal Medicine | Dermatology | 1405 Se 164th Ave Ste 101, Vancouver, WA 98683-9644 | 2020-06-23 |
| 1417599374 | Dermatology Solutions | Dermatology | 8503 W Clearwater Ave Ste B, Kennewick, WA 99336-3100 | 2019-10-11 |
| 1588164925 | Northwest Pediatric Dermatology, Pllc | Dermatology | 703 Lilly Rd Ne Ste 105, Olympia, WA 98506-5191 | 2018-02-12 |
| 1255858247 | Ame Phitwong | Dermatology | 21727 76th Ave W Ste H, Edmonds, WA 98026-7549 | 2017-08-29 |
| 1467879320 | Jayasri Iyer | Dermatology | 9924 Ne 185th St Ste 215, Bothell, WA 98011-3504 | 2014-03-27 |
| 1164869459 | Kaley Myer | Dermatology | 304 W Bay Dr Nw Ste 301, Olympia, WA 98502-4957 | 2013-05-28 |
| 1093158305 | Erica Shantha Tarabadkar | Dermatology | 850 Republican Street, Brotman Room 242, Uw Medical Center At Lake Union, Seattle, WA 98109 | 2013-04-17 |
| 1871835322 | Jason Lee Meeker | Dermatology | 2622 S. Meridian, Puyallup, WA 98373-1500 | 2013-03-22 |
| 1578839494 | Carolina Andrea Simunovic | Dermatology | 1959 Ne Pacific St Rm Bb-1353, Box 356524, Seattle, WA 98195-6524 | 2012-03-25 |
| 1184999260 | April Schachtel | Dermatology | 1660 S Columbian Way Va Puget Sound Health Care System, General Internal Medicine Clinic, Seattle, WA 98108 | 2012-03-21 |
| Find all providers with the same taxonomy | ||||
| City | SPOKANE VALLEY |
| Zip Code | 99212 |
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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.