Organization
NW CARDIOTHORACIC & TRANSPLANT SURGEONS P.S.
Active
Other names
Northwest Cardiothoracic & Transplant Surgeons, PS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY B ICENOGLE M.D. (PRESIDENT)
(509) 623-7575
Entity
Organization
Contact information
Practice address
105 W 8TH AVE, SUITE 532, SPOKANE, WA 99204-2307
(509) 623-7575
(509) 623-7578
Mailing address
105 W 8TH AVE, SUITE 532, SPOKANE, WA 99204-2307
(509) 623-7575
(509) 623-7578
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30277
L&I LICENSE NUMBER
WA
01
—
601433334
STATE LICENSE UBI
WA
Enumeration date
05/24/2006
Last updated
07/09/2008
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