PROVIDENCE PHYSICIAN SERVICE CO (NPI# 1548552326) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548552326 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICE CO |
| Other Organization Name | PMG PROVIDENCE FAMILY MEDICINE SOUTH GRAND |
| Practice Address |
1919 S Grand Ave Pmg Providence Family Medicine South Grand Spokane WA 99204 |
| Mailing Address |
P.o. Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 5092520296 |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-05-11 |
| Authorized Official Name | MR. MICHAEL MALLORY (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 4255256798 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PHYSICIAN SERVICE CO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PMG Providence Family Medicine South Grand | Doing Business As Name - Organization |
| Street Address |
1919 S GRAND AVE PMG PROVIDENCE FAMILY MEDICINE SOUTH GRAND |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204 |
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750916953 | Bavihealth | Family Medicine | 1314 S. Grand Blvd, Ste 2 #142, Spokane, WA 99202-2131 | 2020-03-08 |
| 1407487648 | Direct Primary Care | Family Medicine | 212 E Central Ave Ste 360, Spokane, WA 99208-4502 | 2020-01-27 |
| 1710234190 | Mayfield Family Medicine Pllc | Family Medicine | 5901 N Lidgerwood St Ste 127, Spokane, WA 99208-1122 | 2012-08-06 |
| 1427329762 | Charles Robert Wolfe | Family Medicine | 16320 E Lincoln Rd, Spokane, WA 99217-9571 | 2012-01-18 |
| 1952687386 | Providence Phsyician Services | Family Medicine | 1919 S. Grand Blvd., Spokane, WA 99203 | 2011-10-31 |
| 1295016145 | Providence Physician Services Co | Family Medicine | 801 W. 5th Ave, Suite 307, Spokane, WA 99204 | 2011-09-06 |
| 1104125418 | David Raymond O'brien | Family Medicine | 1907 W Summit Pkwy Apt 306, Spokane, WA 99201-3133 | 2011-03-25 |
| 1144540915 | Elizabeth A. Turner, Md | Family Medicine | 316 W. Boone, Suite 669, Spokane, WA 99201-2354 | 2010-06-03 |
| 1083949374 | Opportunity Medical | Family Medicine | 16201 E. Indiana Ave, Ste 2300, Spokane, WA 99216-2839 | 2009-10-05 |
| 1437483856 | Elizabeth A Deniro | Family Medicine | 2828 W Mallon Ave, Spokane, WA 99201-1553 | 2009-10-01 |
| Find all providers in SPOKANE | ||||
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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.