PROVIDENCE HEALTH CARE (NPI# 1659558476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659558476 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH CARE |
| Other Organization Name | NORTHWEST HEART AND LUNG SURGICAL ASSOCIATES |
| Practice Address |
122 W 7th Ave Ste 330 Spokane WA 99204-2349 |
| Mailing Address |
910 W 5th Ave Ste 380 Spokane WA 99204-2966 |
| Practice Telephone | 5094560262 |
| Practice Fax Number | 5094625059 |
| Mailing Telephone | 5094560262 |
| Mailing Fax Number | 5096248049 |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2008-05-12 |
| Authorized Official Name | MR. KEVIN WALSTROM (CFO) |
| Authorized Official Telephone | 5094743040 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 600503828 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | MEDICARE PTAN | 1370069 | 01 |
| WA | MEDICARE PTAN | 8870848 | 01 |
| WA | 7294903 | 05 | |
| RAILROAD MEDICARE | DG9549 | 01 |
| Other Name | Type Code |
|---|---|
| Northwest Heart and Lung Surgical Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194887588 | Providence Health Care | Respite Care | 6018 N Astor St, Spokane, WA 99208-1107 | 2006-12-14 |
| 1396827424 | Providence Health Care | General Acute Care Hospital | E 1015 'd' Street, Deer Park, WV 99006-0742 | 2006-10-19 |
| 1417057233 | Providence Health Care | General Acute Care Hospital | 1015 East D Street, Deer Park, WA 99006-0742 | 2006-09-22 |
| 1285732602 | Providence Health Care | General Acute Care Hospital | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2006-09-20 |
| 1326033622 | Providence Health Care | Skilled Nursing Facility | 17 E 8th Ave, Spokane, WA 99202-1201 | 2005-09-13 |
| 1184875932 | Providence Health Care | Pharmacy | 101 W 8th Ave, Spokane, WA 99204-2307 | 2008-10-09 |
| 1588831622 | Providence Health Care | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2008-05-08 |
| 1396912432 | Providence Health Care | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2008-05-08 |
| 1720270473 | Providence Health Care | General Acute Care Hospital | 101 W 8th Ave, Spokane, WA 99204-2307 | 2007-08-16 |
| 1043306541 | Providence Health Care | Skilled Nursing Facility | 500 E Webster Ave, Chewelah, WA 99109-9523 | 2006-10-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PROVIDENCE HEALTH CARE | 101 West Eighth Ave, Spokane, WA 99204 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTH CARE FOUNDATION, EASTERN WASHINGTON | 101 W Eight Ave, Spokane, WA 99204-2307 |
| Virginia Business Entities | PROVIDENCE HEALTH CARE INC. | 4500 Dorr St, Toledo, Ohio 43615 |
| Washington State Corporations | PROVIDENCE HEALTH CARE STAFFING INC. | 1040 Randolph St Suite 42, Thomasville, NC 27360 |
| Washington State Corporations | PROVIDENCE HEALTH CARE STAFFING, INC. | 1040 Randolph St Ste 42, Thomasville, NC 27360-6384 |
| Colorado Business Entities | PROVIDENCE HEALTH CARE STAFFING, INC. | 1040 Randolph Street, Suite 42, Thomasville, NC 27360 |
| Washington State Corporations | PROVIDENCE HEALTH CARE VENTURES, INC. | 1801 Lind Ave Sw, Renton, WA 98057-3368 |
| Vermont Business Registrations | PROVIDENCE HEALTH CARE, INC. | 101 East State Street, Kennett Square, PA 19348 |
| Street Address |
122 W 7TH AVE STE 330 |
| City | SPOKANE |
| State | WA |
| Zip Code | 99204-2349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720081979 | Karen L Wollenberg | Registered Nurse | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2005-05-23 |
| 1508484395 | Alia Emilie Soulek | Nurse Practitioner | 122 W 7th Ave, Spokane, WA 99204-2349 | 2020-07-08 |
| 1194239707 | Carrie Joann Estuar | Nurse Practitioner | 122 W 7th Ave, Spokane, WA 99204-2349 | 2017-11-20 |
| 1942736731 | Jessica Keen | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2017-05-11 |
| 1457887937 | Jeremiah Mckee | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2017-05-03 |
| 1003222845 | Kristin Walters | Nurse Practitioner | 122 W 7th Ave, Suite 450, Spokane, WA 99204-2349 | 2014-07-01 |
| 1851669337 | Dacia Kay Murillo | Physician Assistant | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2011-12-12 |
| 1356646202 | Providence Physician Services Co | Surgery | 122 W 7th Ave, Ste 420, Spokane, WA 99204-2349 | 2011-01-24 |
| 1144538158 | Ryan Forsyth | Physician Assistant | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2010-09-24 |
| 1043524481 | Luke Xiaoli Zhan | Surgery | 122 W 7th Ave, Suite 420, Spokane, WA 99204-2349 | 2010-07-27 |
| 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 | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497863773 | Kai A Ihnken | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 122 W 7th Ave Ste 110, Spokane, WA 99204-2301 | 2006-08-28 |
| 1801894811 | Leland G. Siwek | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2005-07-13 |
| 1750523577 | Alexi Matousek | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2009-03-25 |
| 1538311287 | Providence Health & Services-wa | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2008-10-14 |
| 1386805539 | Matthew Donavon Forrester | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2008-06-20 |
| 1720245905 | Justin Reeves | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2008-05-16 |
| 1902898331 | Theodore C Koutlas | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 62 W 7th Ave Ste 110, Spokane, WA 99204-2321 | 2005-08-22 |
| 1114925161 | Donald Vernon Holbert | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 122 W 7th Ave, Ste 110, Spokane, WA 99204-2349 | 2005-07-13 |
| 1902804867 | Michael A Judd | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 122 W 7th Ave, Ste 110, Spokane, WA 99204-2349 | 2005-07-13 |
| 1861490732 | Jack J. Leonard | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 122 W 7th Ave, Ste 110, Spokane, WA 99204-2349 | 2005-07-13 |
| 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.