PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1578869913) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578869913 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Other Organization Name | PROVIDENCE FAMILY MEDICINE NORTH PINES VALLEY |
| Practice Address |
12704 E Nora Ave Ste B Spokane Valley WA 99216-1140 |
| Mailing Address |
12704 E Nora Ave Ste B Spokane Valley WA 99216-1140 |
| Practice Telephone | 5099261531 |
| Mailing Telephone | 5099261531 |
| Enumeration Date | 2011-02-02 |
| 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 | 207Q00000X | Family Medicine | 600503827 | WA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Providence Family Medicine North Pines Valley | 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 |
| 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 |
| 1356646202 | Providence Physician Services Co | Surgery | 122 W 7th Ave, Ste 420, Spokane, WA 99204-2349 | 2011-01-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PROVIDENCE PHYSICIAN SERVICES CO. | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
| Street Address |
12704 E NORA AVE STE B |
| City | SPOKANE VALLEY |
| State | WA |
| Zip Code | 99216-1140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891040457 | Daniel Craig Knott | Massage Therapist | 12704 E Nora Ave, Suite G, Spokane Valley, WA 99216-1140 | 2012-07-19 |
| 1982959532 | Ciree Laray Theisen | Massage Therapist | 12704 E Nora Ave, Suite D, Spokane Valley, WA 99216-1140 | 2012-07-19 |
| 1598010142 | Jessica Leigh Brandt | Massage Therapist | 12704 E Nora Ave, Suite G, Spokane Valley, WA 99216-1140 | 2012-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053920124 | Aark Laboratory | Clinical Medical Laboratory | 12709 E Mirabeau Pkwy Bldg A Ste 500, Spokane, WA 99216 | 2020-07-24 |
| 1922622158 | Vera Whole Health Wa, PC | Clinic/Center | 16009 E Indiana Ave, Spokane Valley, WA 99216 | 2020-06-03 |
| 1023654001 | Rebecca Elizabeth Ryan | Massage Therapist | 12505 E 23rd Ave, Spokane Valley, WA 99216 | 2019-11-25 |
| 1356992903 | Creative Communication LLC | Speech-Language Pathologist | 13607 E. Sprague Ave, Spokane Valley, WA 99216 | 2019-09-25 |
| 1972096584 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15319 E Indiana Ave Ste 2, Spokane Valley, WA 99216 | 2018-06-08 |
| 1356845655 | Rp Operations, LLC | Assisted Living Facility | 13013 E Mission Ave, Spokane Valley, WA 99216 | 2018-03-21 |
| 1174036305 | Talk, Learn and Communicate | Speech-Language Pathologist | 13607 East Spraque Avenue, Spokane Valley, WA 99216 | 2017-11-09 |
| 1134638281 | Vtc Vitality Healthcare | Pain Medicine | 12409 E Mission Ave Ste 102, Spokane Valley, WA 99216 | 2017-09-20 |
| 1285150086 | Robert C Tsay Jr. | Pharmacist | 12415 E 12th Ave, Apt 110, Spokane Valley, WA 99216 | 2017-08-15 |
| 1629505607 | Spokane Valley Medical, Inc | Durable Medical Equipment & Medical Supplies | 12509 E. Mission Ave, Suite #103, Spokane, WA 99216 | 2017-05-22 |
| Find all providers in zip 99216 | ||||
| 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 |
|---|---|---|---|---|
| 1902191372 | Sharon A Bridge | Family Medicine | 9621 E Sprague Ave, Spokane Valley, WA 99206-3618 | 2011-06-14 |
| 1003079294 | Wilfred Alex Madarang | Family Medicine | 924 S Pines Rd, Spokane Valley, WA 99206-5423 | 2008-07-08 |
| 1073661625 | David Clark Gilman | Family Medicine | N 1414 Vereler, Bldg 4, Spokane Valley, WA 99216 | 2007-01-08 |
| 1629144571 | Philip L. Monroe | Family Medicine | 1414 N Vercler Rd Ste 2, Spokane Valley, WA 99216-1092 | 2006-11-24 |
| 1013086693 | Elizabeth M Jansen | Family Medicine | 16528 E Desmet Ct Ste 3100, Spokane Valley, WA 99216-3522 | 2006-11-07 |
| 1730261785 | Bryce Hunter Gilman | Family Medicine | 1414 N Vercler Rd Bldg 4, Spokane Valley, WA 99216-1092 | 2006-10-19 |
| 1720017080 | Pavel Conovalciuc | Family Medicine | 1502 N Vercler Rd, Spokane Valley, WA 99216-1078 | 2006-06-30 |
| 1588691943 | Steven O. Thomas | Family Medicine | 2713 N Argonne Rd, Spokane Valley, WA 99212-2239 | 2006-06-28 |
| 1780611939 | Debra Kay Stanciu | Family Medicine | 15923 E Longfellow Ave, Spokane Valley, WA 99216 | 2006-06-26 |
| 1265403745 | Fredrick Todd Brooking | Family Medicine | 14402 E Sprague Ave Ste 16, Spokane Valley, WA 99216-2167 | 2006-01-31 |
| Find all providers in SPOKANE VALLEY | ||||
| City | SPOKANE VALLEY |
| Zip Code | 99216 |
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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.