Healthcare Provider Details

I. General information

NPI: 1720963945
Provider Name (Legal Business Name): COMMUNITY HEALTH ASSOCIATION OF SPOKANE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LIDGERWOOD ST STE 128
SPOKANE WA
99208-1122
US

IV. Provider business mailing address

731 N IRON BRIDGE WAY
SPOKANE WA
99202-4926
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8888
  • Fax: 509-444-7806
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHAN HALVORSON
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 509-444-8888