Provider Demographics
NPI:1548360654
Name:CHRIST CLINIC
Entity type:Organization
Organization Name:CHRIST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:VIDAL
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-325-0393
Mailing Address - Street 1:914 W CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-3309
Mailing Address - Country:US
Mailing Address - Phone:509-325-0393
Mailing Address - Fax:509-325-7209
Practice Address - Street 1:914 W CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-3309
Practice Address - Country:US
Practice Address - Phone:509-325-0393
Practice Address - Fax:509-325-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7036734Medicaid
WA62797OtherLABOR & INDUSTRIES
WA7036734Medicaid