SPOKANE ORAL SURGERY ASC
NPI 1881065076
Clinic/Center - Ambulatory Surgical in Spokane Valley, WA

Active since October 13, 2015CLIA 50D2169394 · Waiver
12109 E BROADWAY AVE STE C, SPOKANE VALLEY, WA 99206(509) 242-3336(866) 554-1392 Get Directions Write a Review

NPPES record last updated: October 13, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Spokane Oral Surgery Asc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPOKANE ORAL SURGERY ASC (NPI 1881065076) is a healthcare organization registered as an ambulatory surgical in Spokane Valley, Washington and active in the NPI registry since October 2015. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Mark Christopher Paxton, Owner, as its authorized official.

NPPES Registry Identity

NPI1881065076
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameSPOKANE ORAL SURGERY ASC
Location Address12109 E BROADWAY AVE STE CSpokane Valley, WA 99206-6133
Mailing Address12109 E Broadway Ave Ste CSpokane Valley, WA 99206-6133 · (509) 242-3336 · Fax (866) 554-1392
Fax(866) 554-1392
Organization SubpartYesParent: Spokane Oral Surgery
Authorized OfficialMark Christopher PaxtonOwner · (509) 242-3336
Enumeration DateOctober 13, 2015
NPI 1881065076 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
12109 E BROADWAY AVE STE C, Spokane Valley, WA 99206

Other Identifiers 1

Medicare UPING8940493WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2169394

Spokane Oral Surgery · Spokane, WA
Active · expires Apr 4, 2028
CLIA Number50D2169394
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJuly 18, 2019
Certificate Expiration DateApril 4, 2028
Laboratory DirectorTerrance Hauck
Laboratory Phone(509) 242-3336
Laboratory LocationSpokane Oral Surgery9911 N Nevada St Ste 120, Spokane, WA 99218
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Clinic/Center (Podiatric)
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206
Podiatrist
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206
Clinic/Center (Dental)
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206
Podiatrist (Foot & Ankle Surgery)
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206
Podiatrist
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206
Clinic/Center (Ambulatory Surgical)
12109 E BROADWAY AVE STE C
SPOKANE VALLEY, WA 99206

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spokane Oral Surgery ASC's NPI number?

The NPI number for Spokane Oral Surgery ASC is 1881065076. It was assigned to this organization in the NPPES registry on October 13, 2015.

Where is Spokane Oral Surgery ASC located?

Spokane Oral Surgery ASC is located at 12109 E Broadway Ave Ste C, Spokane Valley, WA 99206. The listed phone number is (509) 242-3336.

What is Spokane Oral Surgery ASC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Spokane Oral Surgery ASC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2169394) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Spokane Oral Surgery ASC was last updated on October 13, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.