Healthcare Provider Details

I. General information

NPI: 1730289596
Provider Name (Legal Business Name): WHITMAN MEDICAL GROUP PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W FAIRVIEW ST
COLFAX WA
99111-9552
US

IV. Provider business mailing address

1210 W FAIRVIEW ST
COLFAX WA
99111-9552
US

V. Phone/Fax

Practice location:
  • Phone: 509-397-4717
  • Fax: 509-397-3501
Mailing address:
  • Phone: 509-397-4717
  • Fax: 509-397-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN JAMES HYMAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-397-4717