MEDICARE: SPOKANE UROLOGY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1538870134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE UROLOGY PLLC

Provider Business Mailing Address
First Line	:	1401 E TRENT AVE # 200
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-2902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12525 E MISSION AVE STE 202
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-747-3147
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAYMOND S. LANCE
Credential	:
Telephone Number	:	509-747-3147

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	08/31/2023

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