Healthcare Provider Details

I. General information

NPI: 1871609420
Provider Name (Legal Business Name): ROCKWOOD CLINIC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 E MISSION AVE
SPOKANE VALLEY WA
99216-3101
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: J. CARL BRUESCH
Title or Position: CFO
Credential:
Phone: 509-838-2531