Provider Demographics
NPI:1902864879
Name:SPOKANE SURGERY CENTER LTD PS
Entity Type:Organization
Organization Name:SPOKANE SURGERY CENTER LTD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:PUGMIRE
Authorized Official - Last Name:BRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-928-1990
Mailing Address - Street 1:12109 E BROADWAY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6133
Mailing Address - Country:US
Mailing Address - Phone:509-928-1990
Mailing Address - Fax:509-928-2933
Practice Address - Street 1:12109 E BROADWAY AVE STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6133
Practice Address - Country:US
Practice Address - Phone:509-928-1990
Practice Address - Fax:509-928-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087760Medicaid
WA490000540OtherRAILROAD MEDICARE
WA117682OtherLABOR & INDUSTRY
WA490000540OtherRAILROAD MEDICARE