NPIMap

Organization Active NPI

Cca of Spokane, LLC

  • Physiological Laboratory
  • Spokane, WA
National Provider Identifier
1912934878
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
License
FX00057836 Issued in WA
Legal business name
CCA OF SPOKANE, LLC
Practice address
122 W 7TH Ave
Ste 540
Spokane, WA 99204
Phone
(509) 232-0567
Fax
(509) 232-0571
NPI assigned
Jun 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Authorized official

Name
Mr. John William Combs, RT
Title
Director of Operations
Phone
(509) 232-0567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X FX00057836 WA Primary

Addresses

Primary practice location

122 W 7TH Ave
Ste 540
Spokane, WA 99204

Mailing address

122 W 7TH Ave
Ste 540
Spokane, WA 99204-2349
Phone (509) 232-0567

Other identifiers 3

IdentifierTypeStateIssuer
806709200MedicaidID
P00077314OtherRAILROAD MEDICARE
7120652MedicaidWA

Other names 1

  • Cardiovascular Services of Spokane Doing business as

National Provider Directory

National Provider Directory

Locations

62 W 7th Ave
Ste 540
Spokane, WA 99204
Phone (509) 232-0567

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1912934878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 W 7TH AVE",
            "address_2": "STE 540",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042349",
            "telephone_number": "509-232-0567",
            "fax_number": "509-232-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W 7TH AVE",
            "address_2": "STE 540",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99204",
            "telephone_number": "509-232-0567",
            "fax_number": "509-232-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCA OF SPOKANE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "509-232-0567",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "WA",
            "license": "FX00057836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806709200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00077314",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7120652",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiovascular Services of Spokane",
            "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 Aug 20, 2009; 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.