Provider Demographics
NPI:1619705381
Name:GKM HOLDING INC
Entity type:Organization
Organization Name:GKM HOLDING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:509-808-2835
Mailing Address - Street 1:10518 N ALBERTA RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4483
Mailing Address - Country:US
Mailing Address - Phone:509-808-2835
Mailing Address - Fax:
Practice Address - Street 1:1603 W BELT AVE
Practice Address - Street 2:STE 125
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-808-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty