Organization
NORTHWEST RENAL SVC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEO EUGENE OBERMILLER JR. MD (PRESIDENT)
(509) 744-1500
Entity
Organization
Contact information
Practice address
801 W 5TH AVE, SUITE 509, SPOKANE, WA 99204
(509) 744-1500
(509) 626-5460
Mailing address
801 W 5TH AVE, SUITE 509, SPOKANE, WA 99204
(509) 744-1500
(509) 626-5460
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1109102
MEDICARE
ID
05
—
7098122
—
WA
Enumeration date
09/27/2006
Last updated
07/21/2022
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