MEDICARE: ROCKWOOD CLINIC PS

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		WA

General Provider Information

NPI Number	:	1548707110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKWOOD CLINIC PS

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 E 29TH AVE
Second Line	:	SUITE 100
City	:	SPOKANE
State	:	WA
Zip	:	99223-4868
Country	:	US
Telephone Number	:	509-724-4320
Fax Number	:	509-838-1478

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER MCGOLDRICK
Credential	:
Telephone Number	:	509-342-3709

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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Directions to “ROCKWOOD CLINIC PS ” Practice Location

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