Roth Medical Clinic, Llc | |
220 E Rowan Ave Ste 200 Spokane WA 99207-1203 | |
(509) 483-4403 | |
(509) 489-7556 |
Full Name | Roth Medical Clinic, Llc |
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Speciality | Clinic/Center |
Location | 220 E Rowan Ave Ste 200, Spokane, Washington |
Authorized Official Name and Position | William Terrence Roth (OWNER) |
Authorized Official Contact | 5094834403 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Roth Medical Clinic, Llc 220 E Rowan Ave Ste 200 Spokane WA 99207-1203 Ph: (509) 483-4403 | Roth Medical Clinic, Llc 220 E Rowan Ave Ste 200 Spokane WA 99207-1203 Ph: (509) 483-4403 |
NPI Number | 1861783847 |
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Provider Enumeration Date | 04/26/2011 |
Last Update Date | 04/26/2011 |
Medicare PECOS PAC ID | 4183514714 |
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Medicare Enrollment ID | O20040317001429 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861783847 | NPI | - | NPPES |
1111145 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | MD 00035230 (Washington) | Primary |
Provider Name | William T Roth |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124199989 PECOS PAC ID: 3274524731 Enrollment ID: I20040521001322 |
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