Organization
NORTHWEST RENAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO EUGENE OBERMILLER JR. MD (PRESIDENT)
(509) 744-1500
Entity
Organization
Contact information
Practice address
801 W 5TH AVE, SUITE #323, SPOKANE, WA 99204-2823
(509) 744-1500
(509) 626-5460
Mailing address
801 W 5TH AVE, SUITE #323, SPOKANE, WA 99204-2823
(509) 744-1500
(509) 626-5460
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
601983029
WA
207RN0300X
Nephrology Physician
Primary
601983029
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010100010060
REGENCE BLUE SHIELD OF ID
—
05
—
7098122
—
WA
Enumeration date
04/11/2007
Last updated
01/19/2010
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