Provider Demographics
NPI:1902056583
Name:WA-SPOK KIDNEY CARE LLC
Entity Type:Organization
Organization Name:WA-SPOK KIDNEY CARE LLC
Other - Org Name:KIDNEY CARE SPOKANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOF
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2851
Mailing Address - Country:US
Mailing Address - Phone:800-703-7345
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:801 WEST FIFTH AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2841
Practice Address - Country:US
Practice Address - Phone:509-473-3796
Practice Address - Fax:509-473-3793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WA SPOK KIDNEY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-19
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0241851OtherDEPT OF L&I
WA7144520Medicaid
WAG8876353Medicare PIN