MEDICARE: NEW LEAF HYPERBARICS OF SPOKANE VALLEY

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	261Q00000X	Clinic/Center	603583588	WA

General Provider Information

NPI Number	:	1891145280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LEAF HYPERBARICS OF SPOKANE VALLEY

Provider Business Mailing Address
First Line	:	16201 E INDIANA AVE
Second Line	:	3260
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-315-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	16201 E INDIANA AVE
Second Line	:	3260
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-315-9119
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. CRISTAH CAVANAUGH-M.
Credential	:
Telephone Number	:	509-315-9119

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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