=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811314677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA S BLISS MD PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2014
-----------------------------------------------------
Last Update Date | 06/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15404 E SPRINGFIELD AVE SUITE L201
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-868-0938
-----------------------------------------------------
Fax | 509-892-9998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15404 E SPRINGFIELD AVE SUITE L201
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-868-0938
-----------------------------------------------------
Fax | 509-892-9998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LISA S BLISS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 509-868-0938
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | MD00042250
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------