PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1093032757) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093032757 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Other Organization Name | PPS PSHMC PEDS ENDOCRINOLOGY |
| Practice Address |
101 W 8th Ave Ste 100 L-1 Spokane WA 99204-2307 |
| Mailing Address |
101 W 8th Ave Mother Gamelin Center, 3rd Floor Spokane WA 99204-2307 |
| Practice Telephone | 5094742880 |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2011-02-18 |
| Authorized Official Name | ANSELMO NUNEZ (CHIEF EXECUTIVE) |
| Authorized Official Telephone | 5094746616 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PPS PSHMC PEDS ENDOCRINOLOGY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740566173 | Providence Physician Services Co | Internal Medicine | 212 Central Ave Suite 440, Spokane, WA 99208 | 2011-10-31 |
| 1295016145 | Providence Physician Services Co | Family Medicine | 801 W. 5th Ave, Suite 307, Spokane, WA 99204 | 2011-09-06 |
| 1619268281 | Providence Physician Services Co | Family Medicine | 100 W. South Ave Chewelah, Chewelah, WA 99109 | 2011-04-29 |
| 1184915829 | Providence Physician Services Co | Family Medicine | 5011 W. Lowell Ave, Seattle, WA 99208-8587 | 2011-04-28 |
| 1578869913 | Providence Physician Services Co | Family Medicine | 12704 E Nora Ave, Ste B, Spokane Valley, WA 99216-1140 | 2011-02-02 |
| 1891001277 | Providence Physician Services Co | Pediatrics | 5901 N Linderwood, Suite 126, Spokane, WA 99207 | 2010-08-24 |
| 1245557917 | Providence Physician Services Co | Obstetrics & Gynecology | 518 Clay Street, Chewelah, WA 99109 | 2010-04-21 |
| 1215223953 | Providence Physician Services Co | Prosthetic/Orthotic Supplier | 101 W 8th Ave, Mother Gamelin Center, 3rd Floor, Spokane, WA 99204-2307 | 2011-06-21 |
| 1336433812 | Providence Physician Services Co | Family Medicine | 104 W 5th Ave, Suite 390e, Spokane, WA 99204 | 2011-06-02 |
| 1053618892 | Providence Physician Services Co | Internal Medicine | 105 W 8th Ave, Ste 550e, Spokane, WA 99204-2302 | 2011-02-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PROVIDENCE PHYSICIAN SERVICES CO. | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
| Street Address |
101 W 8TH AVE STE 100 L-1 |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204-2307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003819319 | Sacred Heart Medical Center | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2005-05-31 |
| 1124626841 | Melissa Ann Benson | Respiratory Therapist, Registered | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-10-14 |
| 1184236671 | Margaret Ann Warren | Physical Therapist | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-08-18 |
| 1265044747 | Melyssa Carlson | Registered Nurse | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-08-17 |
| 1760091276 | Corle Morefield | Pharmacist | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-07-30 |
| 1174143663 | Ashley Kay Gardiner | Student in an Organized Health Care Education/Training Program | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-04-24 |
| 1265061485 | Mary Katherine Griessmann | Social Worker | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-04-08 |
| 1558990994 | Ingrid Mary Agnew | Social Worker | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-04-07 |
| 1952930562 | Cody Key | Student in an Organized Health Care Education/Training Program | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-04-06 |
| 1417586173 | Samuel Logan | Student in an Organized Health Care Education/Training Program | 101 W 8th Ave, Spokane, WA 99204-2307 | 2020-04-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982250957 | Megan Elizabeth Dibenedetto | Pharmacist | 105 West 8th Avenue, 350e, Spokane, WA 99204 | 2019-08-14 |
| 1619521168 | Evelyn R Cabon | Genetic Counselor, MS | 101 W. 8th Avenue Suite 1100, Spokane, WA 99204 | 2019-08-01 |
| 1346700655 | Christina Rose | Student in an Organized Health Care Education/Training Program | 120 W. 8th Avenue, Spokane, WA 99204 | 2019-03-22 |
| 1508339862 | Cody J French | Physical Therapist | Washington Outpatient Rehab, 507 S Washington, Spokane, WA 99204 | 2019-01-09 |
| 1730655598 | Washington Outpatient Rehabilitation, LLC | Physical Therapist | 507 S. Washington St., Suite 10, Spokane, WA 99204 | 2018-10-19 |
| 1013405547 | Joel James Hayden | Student in an Organized Health Care Education/Training Program | Providence Sacred Heart, 101 West 8th Avenue, Spokane, WA 99204 | 2018-04-30 |
| 1144694787 | Brooksjohnsonpllc | Dentist | 1004 S. Monroe Street, Ste 100, Spokane, WA 99204 | 2015-11-19 |
| 1497184196 | Kathalene M Cassels | Physician Assistant | 810 W. 5th Ave. Ste 510, Spokane, WA 99204 | 2013-11-04 |
| 1174880454 | Kelly E Wurzel | Psychiatry & Neurology | 624 E. Front Ave, Spokane, WA 99204 | 2012-04-11 |
| 1003190331 | Katie L Gomez | Nurse Practitioner | 805 W. 5th Ave, Suite 518, Spokane, WA 99204 | 2011-10-05 |
| Find all providers in zip 99204 | ||||
| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477609147 | Christopher Kishiyama | Pediatrics | 101 W 8th Ave L1, Ste 100, Spokane, WA 99204-2307 | 2007-01-26 |
| 1316113335 | Radha Nandagopal | Pediatrics | 101 W 8th Ave, Suite 100 L-1, Spokane, WA 99204-2307 | 2008-04-30 |
| 1639225246 | Christina Gerhardt | Pediatrics | 101 W 8th Ave, Suite 100 L1, Spokane, WA 99204-2307 | 2007-01-26 |
| 1306898598 | Jeanne M Hassing | Pediatrics | 400 E 5th Ave, Spokane, WA 99202-1334 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366767428 | David Michael Werny | Pediatrics | 4800 Sand Point Way Ne # Ms 7.820, Seattle, WA 98105-3901 | 2010-04-01 |
| 1124096565 | Robert Jay Newman | Pediatrics | Mchj-p (pediatrics), Madigan Army Medical Center, Tacoma, WA 98431-1100 | 2006-03-10 |
| 1720063902 | Patricia Yvonne Fechner | Pediatrics | 4800 Sand Poin Way Ne, M/s A5902, Seattle, WA 98105-0371 | 2005-12-12 |
| 1346611514 | Siu Ying Nip | Pediatrics | 4800 Sand Point Way Ne, Endocrinology Department M/s Oc.7.820, Seattle, WA 98105-3901 | 2015-10-14 |
| 1558788455 | Meenal Gupta | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2014-03-28 |
| 1326481243 | Sara Akhtar Ali | Pediatrics | 1550 S Pioneer Way Ste 370, Moses Lake, WA 98837-4618 | 2013-04-10 |
| 1013216803 | Alissa Jeanne Curda Roberts | Pediatrics | 4800 Sand Point Way Ne # A-5950, Seattle, WA 98105-3901 | 2011-03-20 |
| 1497991848 | Ildiko Hrabovszky Koves | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2009-01-06 |
| 1306050091 | Carolina Di Blasi | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 09105 | 2007-05-10 |
| 1548481609 | Grace J Kim | Pediatrics | 4800 Sand Point Way Ne, Seattle Childrens Hospital Mis Oc 7.820, Seattle, WA 98105 | 2007-05-02 |
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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.