MEDICARE: DR. NATHAN P STIME MD

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	207Q00000X	Family Medicine Physician	10797	WA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912976838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN P STIME MD

Provider Business Mailing Address
First Line	:	34705 N NEWPORT HWY
Second Line	:	SUITE A
City	:	CHATTAROY
State	:	WA
Zip	:	99003-7711
Country	:	US
Telephone Number	:	509-292-2700
Fax Number	:	509-292-9744

Provider Business Practice Location Address
First Line	:	34705 N NEWPORT HWY
Second Line	:	SUITE A
City	:	CHATTAROY
State	:	WA
Zip	:	99003-7711
Country	:	US
Telephone Number	:	509-292-2700
Fax Number	:	509-292-9744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/05/2007

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