PROVIDENCE PHYSICIAN SERVICES CO (NPI# 1700103462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700103462 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN SERVICES CO |
| Other Organization Name | PPS PSHMC DEVELOPMENTAL PEDIATRICS |
| Practice Address |
101 W 8th Ave Ste 4200 Spokane WA 99204-2307 |
| Mailing Address |
101 W 8th Ave Mother Gamelin Center, 3rd Floor Spokane WA 99204-2307 |
| Practice Telephone | 5094742730 |
| Mailing Telephone | 5094746616 |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2011-02-28 |
| 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 | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PPS PSHMC DEVELOPMENTAL PEDIATRICS | 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 4200 |
| 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 | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831146968 | Providence Physician Services Co. | Pediatrics | 101 W 8th Ave, Mother Gamelin Center 3rd Flr, Spokane, WA 99204-2307 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275533838 | Lilliam A Sierra | Pediatrics | 7301 W Deschutes Ave, Suite A, Kennewick, WA 99336-7757 | 2005-07-26 |
| 1215460860 | Kira Belzer | Pediatrics | Madigan Army Medical Center 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2017-04-10 |
| 1568880276 | Angela J Armen | Pediatrics | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2014-03-31 |
| 1790910701 | Lisa Diane Herzig | Pediatrics | 4800 Sand Point Way Ne, M/s Oc.9.840, Seattle, WA 98105-3901 | 2009-05-19 |
| 1710135926 | Emily Myers | Pediatrics | 4800 Sand Point Way Ne, Oc.9.840, Seattle, WA 98105-3901 | 2008-08-29 |
| 1093931339 | Sterling K Clarren | Pediatrics | 2142 10th Ave W, Seattle Children's Home, Seattle, WA 98119-2845 | 2007-04-17 |
| 1073646469 | Natasha Hays | Pediatrics | 677 Woodland Square Loop Se, Lacey, WA 98503-1000 | 2007-03-14 |
| 1205972791 | Deanna Sue Livingstone | Pediatrics | 9040 Reid Street, A, Tacoma, WA 98431-1100 | 2007-01-30 |
| 1922167220 | Theodore Dungan Mandelkorn | Pediatrics | 2553 76th Ave Se, Mercer Island, WA 98040-2758 | 2006-12-06 |
| 1912065889 | David Laverne Burkebile | Pediatrics | 601 S Carr Rd, Suite 420, Renton, WA 98055-5866 | 2006-12-04 |
| Find all providers with the same taxonomy | ||||
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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.