Healthcare Provider Details

I. General information

NPI: 1891629549
Provider Name (Legal Business Name): LILAC CITY MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W LAMAR AVE
SPOKANE WA
99208-9131
US

IV. Provider business mailing address

4913 W LAMAR AVE
SPOKANE WA
99208-9131
US

V. Phone/Fax

Practice location:
  • Phone: 509-881-9548
  • Fax: 509-816-1966
Mailing address:
  • Phone: 509-881-9548
  • Fax: 509-816-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT JAMES COOK
Title or Position: OWNER/OPERATOR
Credential:
Phone: 509-881-9548