Healthcare Provider Details

I. General information

NPI: 1093107328
Provider Name (Legal Business Name): TOUCHMARK ON SOUTH HILL LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S WATERFORD DR
SPOKANE WA
99203-4400
US

IV. Provider business mailing address

5150 SW GRIFFITH DR
BEAVERTON OR
97005-2935
US

V. Phone/Fax

Practice location:
  • Phone: 509-536-2929
  • Fax: 509-536-3999
Mailing address:
  • Phone: 503-646-5186
  • Fax: 503-644-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60204231
License Number StateWA

VIII. Authorized Official

Name: BRIAN EUGENE PRYOR
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 503-646-5186