Healthcare Provider Details

I. General information

NPI: 1497205652
Provider Name (Legal Business Name): COMMUNITY HEALTH ASSOCIATION OF SPOKANE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S MAIN ST STE 120
MOSCOW ID
83843
US

IV. Provider business mailing address

731 N IRON BRIDGE WAY
SPOKANE WA
99202-4926
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-8300
  • Fax: 208-882-5587
Mailing address:
  • Phone: 509-444-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN HALVORSON
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 509-444-8888