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General NPI Number Information
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NPI Number | 1336445634
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Entity Type | Organization
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Legal Business Name | EMERGENCY PHYSICIAN SERVICES PS HOLY EMERGENCY CENTER
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 5633 N LIDGERWOOD ST
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City | SPOKANE
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State | WA
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Zip | 99208-1224
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Country | US
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Telephone | 509-482-2448
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Fax | 509-482-2452
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Provider Business Mailing Address
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Address Line | 5633 N LIDGERWOOD ST
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City | SPOKANE
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State | WA
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Zip | 99208-1224
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Country | US
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Telephone | 509-482-2448
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Fax | 509-482-2452
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK C WHITMAN
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Credential |
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Telephone | 509-482-2448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 601038135
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License Number State | WA
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