Healthcare Provider Details

I. General information

NPI: 1023253374
Provider Name (Legal Business Name): BOURGET HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W CLIFF DR
SPOKANE WA
99204-3638
US

IV. Provider business mailing address

PO BOX 2687
SPOKANE WA
99220-2687
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-8600
  • Fax: 509-755-8319
Mailing address:
  • Phone: 509-755-8600
  • Fax: 509-755-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTS-0416
License Number StateWA

VIII. Authorized Official

Name: MR. KURT ROGERS
Title or Position: CFP
Credential:
Phone: 509-755-8903