| Country Doctors | |
|
1201 N Evergreen Rd Spokane Valley WA 99216-5094 | |
| (509) 951-3979 | |
| (509) 495-1244 |
| Full Name | Country Doctors |
|---|---|
| Speciality | Internal Medicine |
| Location | 1201 N Evergreen Rd, Spokane Valley, Washington |
| Authorized Official Name and Position | Robert Iver Hustrulid (OWNER) |
| Authorized Official Contact | 5099513979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Country Doctors 3807 S Sommer Rd Veradale WA 99037-9136 Ph: (509) 951-3979 | Country Doctors 1201 N Evergreen Rd Spokane Valley WA 99216-5094 Ph: (509) 951-3979 |
| NPI Number | 1265049829 |
|---|---|
| Provider Enumeration Date | 09/28/2020 |
| Last Update Date | 12/21/2020 |
| Certification Date | 12/21/2020 |
| Medicare PECOS PAC ID | 7113347642 |
|---|---|
| Medicare Enrollment ID | O20210115001638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265049829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Robert Iver Hustrulid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528079217 PECOS PAC ID: 5193817799 Enrollment ID: I20210115001703 |
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