Spokane ENT Clinic Mayfair

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

MD00019284 Issued in WA

Legal business name

SPOKANE ENT CLINIC MAYFAIR

Practice address

5901 N Mayfair St
Spokane, WA 99208-5096

Phone

(509) 489-3514

Fax

(509) 483-2546

NPI assigned

Jun 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Direndia Shackelford

Title

Managed Care Specialist

Phone

(800) 654-0889

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• JAN S CONNELLY MD Doing business as

Tax ID family

Columbia Surg Spec PS2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Spokane Ear Nose and Throat Clinic

  • Non-Pharmacy Dispensing Site
  • Spokane, WA
  • NPI 1053366807
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033154273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 N MAYFAIR ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992085096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N MAYFAIR ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992085096",
            "telephone_number": "509-489-3514",
            "fax_number": "509-483-2546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPOKANE ENT CLINIC MAYFAIR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WA",
            "license": "MD00019284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4931906",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JAN S CONNELLY MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Spokane Emdr & Counseling PLLC
• Spokane Emergency Care Physicians PLLC
• Spokane Emergency Group, a Professional LLC
• Spokane Emergency Medicine Associates, PS
• Spokane Emergency Physicians, PS
• Spokane Eye Clinic PS
• Spokane Eye Clinic PS
• Spokane Eye Clinic PS
• Spokane Eye Clinic PS
• Spokane Falls Care LLC

• Non-Pharmacy Dispensing Site in Spokane, WA
• Providers in Spokane, WA by specialty
• Non-Pharmacy Dispensing Site in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.