Healthcare Provider Details

I. General information

NPI: 1801987797
Provider Name (Legal Business Name): NORTHWEST RENAL SVC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE SUITE 509
SPOKANE WA
99204
US

IV. Provider business mailing address

801 W 5TH AVE SUITE 509
SPOKANE WA
99204
US

V. Phone/Fax

Practice location:
  • Phone: 509-744-1500
  • Fax: 509-626-5460
Mailing address:
  • Phone: 509-744-1500
  • Fax: 509-626-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: LEO EUGENE OBERMILLER JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 509-744-1500