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General NPI Number Information
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NPI Number | 1023310489
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PHYSICIAN SERVICES CO
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 820 S MCCLELLAN STE 300
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City | SPOKANE
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State | WA
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Zip | 99204-2450
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Country | US
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Telephone | 509-838-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W 8TH AVE MOTHER GAMELIN CENTER, 3RD FLOOR
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City | SPOKANE
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State | WA
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Zip | 99204-2307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE
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Name | ANSELMO NUNEZ
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Credential | MD
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Telephone | 509-474-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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