Healthcare Provider Details

I. General information

NPI: 1750916953
Provider Name (Legal Business Name): BAVIHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N RIVERPOINT BLVD
SPOKANE WA
99202-1610
US

IV. Provider business mailing address

412 E SPOKANE FALLS BLVD
SPOKANE WA
99202-2131
US

V. Phone/Fax

Practice location:
  • Phone: 509-505-7481
  • Fax:
Mailing address:
  • Phone: 509-505-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BOCARDO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 509-505-7481