Healthcare Provider Details

I. General information

NPI: 1881786069
Provider Name (Legal Business Name): NEUROSURGERY & SPINE ASSOCIATES, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W. 8TH AVENUE STE 200
SPOKANE WA
99204-2318
US

IV. Provider business mailing address

105 W. 8TH AVENUE STE 200
SPOKANE WA
99204-2318
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-9112
  • Fax: 509-624-1087
Mailing address:
  • Phone: 509-624-9112
  • Fax: 509-624-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT DEAN MARTZ
Title or Position: AUTH OFFICIAL
Credential: M.D.
Phone: 509-624-9112