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General NPI Number Information
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NPI Number | 1295135598
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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 | 08/25/2014
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 212 E CENTRAL AVE SUITE 245
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City | SPOKANE
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State | WA
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Zip | 99208-6291
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Country | US
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Telephone | 509-465-3026
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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 | 509-474-7317
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Fax |
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Authorized Official
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Title or Position | CHIEF REIMBURSEMENT OFFICER
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Name | BILLIE JEAN MOUNTS
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Credential |
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Telephone | 425-687-3910
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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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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