Healthcare Provider Details

I. General information

NPI: 1285644195
Provider Name (Legal Business Name): EDWIN M TINGSTAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 120
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

2500 W A ST SUITE 201
MOSCOW ID
83843-6000
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM8045
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37180
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1110857
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier1003546
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 3
Identifier135969
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWA DEPT OF LABOR
# 4
Identifier805780700
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: