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NPI Code Detail

MEDICARE: ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC

MEDICARE: ADVANCED DERMATOLOGY AND SKIN SURGERY, 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
1261QA1903XAmbulatory Surgical Clinic/CenterID
2261QA1903XAmbulatory Surgical Clinic/Center601724644WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00114626OTHERWARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710952882
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC
Provider Business Mailing Address
First Line : 1807 N HUTCHINSON RD
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-2444
Country : US
Telephone Number : 509-456-7414
Fax Number : 509-624-0763
Provider Business Practice Location Address
First Line : 1807 N HUTCHINSON RD
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-2444
Country : US
Telephone Number : 509-456-7414
Fax Number : 509-624-0763
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : JOEL K SEARS
Credential : M.D.
Telephone Number : 509-456-7414
Provider Enumeration Date : 02/21/2006
Last Update Date : 04/26/2018

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