Healthcare Provider Details

I. General information

NPI: 1033242193
Provider Name (Legal Business Name): SPOKANE DIGESTIVE DISEASE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E ROWAN AVE
SPOKANE WA
99207-1232
US

IV. Provider business mailing address

46 E ROWAN AVE
SPOKANE WA
99207-1232
US

V. Phone/Fax

Practice location:
  • Phone: 509-487-1669
  • Fax: 509-487-7773
Mailing address:
  • Phone: 509-487-1669
  • Fax: 509-487-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberFX00056575
License Number StateWA

VIII. Authorized Official

Name: MS. DOREENE A MOTT
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-838-5950