Healthcare Provider Details

I. General information

NPI: 1861623746
Provider Name (Legal Business Name): BROWN TROUT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 S. MONROE
SPOKANE WA
99204-3836
US

IV. Provider business mailing address

3704 N. NEVADA ST.
SPOKANE WA
99207-2968
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-3145
  • Fax: 509-489-4527
Mailing address:
  • Phone: 509-489-4500
  • Fax: 509-489-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT THOMAS CORDIER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 509-321-9091