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General NPI Number Information
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NPI Number | 1124981832
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Entity Type | Organization
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Legal Business Name | WSK12 ENTERPRISE GROUP INC.
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 707 W MAIN AVE
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City | SPOKANE
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State | WA
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Zip | 99201-0643
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Country | US
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Telephone | 509-475-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 707 W MAIN AVE
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City | SPOKANE
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State | WA
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Zip | 99201-0643
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Country | US
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Telephone | 509-475-0249
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NATHANIEL L WITHEROW
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Credential |
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Telephone | 509-475-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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