Healthcare Provider Details

I. General information

NPI: 1134137599
Provider Name (Legal Business Name): SPOKANE PLASTIC SURGEONS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E ROWAN AVE STE 206
SPOKANE WA
99207-1240
US

IV. Provider business mailing address

235 E ROWAN AVE STE 206
SPOKANE WA
99207-1240
US

V. Phone/Fax

Practice location:
  • Phone: 509-484-1212
  • Fax: 509-484-1277
Mailing address:
  • Phone: 509-484-1212
  • Fax: 509-484-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: MRS. MARLENE ANN CROW
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-484-1212