MEDICARE: INLAND NORTHWEST SURGERY CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P000000388	WA
2	213E00000X	Podiatrist	P000000698	WA
3	261QA1903X	Ambulatory Surgical Clinic/Center	6011706837	WA
4	213E00000X	Podiatrist	P000000333	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DD3019	OTHER	WA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0143764	OTHER	WA	LABOR INDUSTRIES

General Provider Information

NPI Number	:	1134127657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND NORTHWEST SURGERY CENTER PLLC

Provider Business Mailing Address
First Line	:	526 N MULLAN RD
Second Line	:	SUITE A & B
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-2407
Country	:	US
Telephone Number	:	509-924-2600
Fax Number	:	509-926-9865

Provider Business Practice Location Address
First Line	:	526 N MULLAN RD
Second Line	:	SUITE A & B
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-2407
Country	:	US
Telephone Number	:	509-924-2600
Fax Number	:	509-926-9865

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. THOMASIN K HAMMER
Credential	:	DPM
Telephone Number	:	509-924-2600

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	03/07/2019

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