Providence Physician Services Co

NPI #1578869913 in Spokane Valley, Washington

Provider Information

NPI Number
1578869913
Entity Type
Organization
Organization Name
Providence Physician Services Co
Subpart
Yes (part of a larger organization)
Parent Organization
PROVIDENCE PHYSICIAN SERVICES CO
Primary Specialty
Family Medicine
Enumeration Date
Feb 2, 2011
Last Updated
Feb 18, 2011

Practice Location

Address
12704 E NORA AVE
Address 2
STE B
ZIP Code
99216-1140
Phone
(509) 926-1531

Authorized Official

Name
ANSELMO NUNEZ
Title
CHIEF EXECUTIVE
Phone
(509) 474-6616

Specialties & Taxonomy Codes

Specialty
Family Medicine

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