Healthcare Provider Details

I. General information

NPI: 1811288897
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2167
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-2625
  • Fax: 509-922-4001
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY BEERY
Title or Position: DIRECTOR
Credential:
Phone: 206-630-1818