MEDICARE: SPOKANE SURGERY CENTER LTD 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	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	490000540	OTHER	WA	RAILROAD 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
3	117682	OTHER	WA	LABOR & INDUSTRY

General Provider Information

NPI Number	:	1902864879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE SURGERY CENTER LTD PS

Provider Business Mailing Address
First Line	:	12109 E BROADWAY AVE STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6133
Country	:	US
Telephone Number	:	509-928-1990
Fax Number	:	509-928-2933

Provider Business Practice Location Address
First Line	:	12109 E BROADWAY AVE STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6133
Country	:	US
Telephone Number	:	509-928-1990
Fax Number	:	509-928-2933

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. STEWART PUGMIRE BRIM
Credential	:	DPM
Telephone Number	:	509-928-1990

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/04/2024

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Directions to “SPOKANE SURGERY CENTER LTD PS ” Practice Location

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