MEDICARE: JAMES NATHAN SLEDGE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10004780	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457319584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES NATHAN SLEDGE PAC

Provider Business Mailing Address
First Line	:	546 N JEFFERSON LN STE 200
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-7104
Country	:	US
Telephone Number	:	509-625-3700
Fax Number	:	509-625-3747

Provider Business Practice Location Address
First Line	:	546 N JEFFERSON LN STE 200
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-7104
Country	:	US
Telephone Number	:	509-625-3700
Fax Number	:	509-625-3747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	05/05/2021

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Directions to “ JAMES NATHAN SLEDGE PAC” Practice Location

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