Healthcare Provider Details

I. General information

NPI: 1811147283
Provider Name (Legal Business Name): WA-SPOK VH URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 N ARGONNE RD
SPOKANE VALLEY WA
99212-2239
US

IV. Provider business mailing address

2713 N ARGONNE RD
SPOKANE VALLEY WA
99212-2239
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-9254
  • Fax: 509-922-7294
Mailing address:
  • Phone: 509-922-9254
  • Fax: 509-922-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBBIE T BREWER
Title or Position: DIRECTOR
Credential:
Phone: 877-892-9813