=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861506289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPOKANE VALLEY EAR, NOSE &THROAT, P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 05/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424 N MCDONALD RD STE 101
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99216-6017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-928-7272
-----------------------------------------------------
Fax | 509-928-7346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1424 N. MCDONALD RD SUITE 101
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99216-1088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-928-7272
-----------------------------------------------------
Fax | 509-928-7346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ERIC BRYAN LEAVITT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 509-928-7272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------