NPIMap

Organization Active NPI

NW Cardiothoracic & Transplant Surgeons P.S.

Doing business as Northwest Cardiothoracic & Transplant Surgeons, PS

  • Transplant Surgery Physician
  • Spokane, WA
National Provider Identifier
1336194703
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Transplant Surgery PhysicianTaxonomy code 204F00000X
Legal business name
NW CARDIOTHORACIC & TRANSPLANT SURGEONS P.S.
Doing business as
Northwest Cardiothoracic & Transplant Surgeons, PS
Practice address
105 W 8TH Ave
Suite 532
Spokane, WA 99204-2307
Phone
(509) 623-7575
Fax
(509) 623-7578
NPI assigned
May 24, 2006
Last updated
Jul 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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

Authorized official

Name
Dr. Timothy B Icenogle, M.D.NPI 1285683029
Title
President
Phone
(509) 623-7575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

105 W 8TH Ave
Suite 532
Spokane, WA 99204-2307

Mailing address

105 W 8TH Ave
Suite 532
Spokane, WA 99204-2307
Phone (509) 623-7575

Other identifiers 2

IdentifierTypeStateIssuer
30277OtherWAL&I LICENSE NUMBER
601433334OtherWASTATE LICENSE UBI

Other names 1

  • Northwest Cardiothoracic & Transplant Surgeons, PS Doing business as

National Provider Directory

National Provider Directory

Locations

105 W 8th Ave
Ste 532
Spokane, WA 99204
Phone (509) 623-7575

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1336194703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE",
            "address_2": "SUITE 532",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-623-7575",
            "fax_number": "509-623-7578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE",
            "address_2": "SUITE 532",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-623-7575",
            "fax_number": "509-623-7578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW CARDIOTHORACIC & TRANSPLANT SURGEONS P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "ICENOGLE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-623-7575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I LICENSE NUMBER",
            "identifier": "30277",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE UBI",
            "identifier": "601433334",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Cardiothoracic & Transplant Surgeons, PS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.