MEDICARE: SPOKANE REGIONAL HEALTH DISTRICT

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM2800X	Methadone Clinic
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	291U00000X	Clinical Medical Laboratory	50D0672084	WA
5	251K00000X	Public Health or Welfare Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	600001762	OTHER		MEDICARE RAILROAD
7	G000312380	OTHER	WA	MEDICARE GROUP PIN

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
3	0117197	OTHER	WA	LABOR & INDUSTRIES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811954373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE REGIONAL HEALTH DISTRICT

Provider Business Mailing Address
First Line	:	1101 W COLLEGE AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2029
Country	:	US
Telephone Number	:	509-324-1660
Fax Number	:	509-324-3609

Provider Business Practice Location Address
First Line	:	1101 W COLLEGE AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2029
Country	:	US
Telephone Number	:	509-324-1660
Fax Number	:	509-324-3609

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	PAULA MAXWELL
Credential	:
Telephone Number	:	509-324-1660

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	12/19/2023

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Directions to “SPOKANE REGIONAL HEALTH DISTRICT ” Practice Location

Language	Start Address	Practice Location

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