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General NPI Number Information
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NPI Number | 1376512293
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Entity Type | Organization
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Legal Business Name | NATHAN P STIME MD RIVERSIDE MEDICAL-DENTAL CLINIC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 34705 N NEWPORT HWY SUITE A
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City | CHATTAROY
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State | WA
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Zip | 99003-7711
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Country | US
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Telephone | 509-292-2700
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Fax | 509-292-9744
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Provider Business Mailing Address
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Address Line | 34705 N NEWPORT HWY SUITE A
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City | CHATTAROY
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State | WA
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Zip | 99003-7711
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Country | US
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Telephone | 509-292-2700
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Fax | 509-292-9744
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN P STIME
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Credential | MD
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Telephone | 509-292-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10797
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License Number State | WA
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