| NPI Number | 1093077034 |
| Provider Name | Eric Cohen |
| Credential | |
| Specialization | |
| Medical School Name | Other |
| Graduation Year | 2012 |
| Gender | M |
| Entity Type | Individual |
| PAC ID by PECOS | 1850606948 |
| Professional Enrollment ID | I20160727002751 |
| Enumeration Date | 06/14/2012 |
| Last Update Date | 08/22/2016 |
| Business Practice address |
105 W 8TH AVE, Spokane, 99204-2302 Washington View on Google Map |
| Business Practice phone | 509-474-6920 |
| Business Practice fax | 509-474-3014 |
| Mailing address |
PO BOX 421, Liberty Lake, 99019-0421 Washington View on Google Map |
| Other phone | 866-747-2455 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Prov Sacred Hrt Med Ctr & Childs Hosp. in Spokane
Spokane, Washington
Other
2012
| Organization Name | PECOS PAC ID | Members | |
|---|---|---|---|
|
Providence Health And Services Washington | 0345139929 | 680 |
| Field Name | Field Value |
|---|---|
| NPI | 1093077034 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
|
| Is Sole Proprietor | N |
Indicate whether provider is a sole proprietor.
|
|
| Provider Last Name (Legal Name) | Cohen |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Eric |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | M.D. |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | PO BOX 421 |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Liberty Lake |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Washington |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 99019-0421 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 866-747-2455 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 105 W 8TH AVE |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | Spokane |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Washington |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 99204-2302 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 509-474-6920 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Business Practice Location Address Fax Number | 509-474-3014 |
| The fax number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 06/14/2012 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 08/22/2016 |
| The date that a record was last updated or changed. | |
| Provider Gender Code | M |
| The code designating the provider's gender if the provider is a person. | |
| Provider Gender | Male |
| The provider's gender if the provider is a person. | |
| Healthcare Provider Taxonomy Code #1 | 273R00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Healthcare Provider Taxonomy #1 | |
| Provider License Number 1 | RL1239 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 1 | ND |
| Provider License Number State Code #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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|
| Healthcare Provider Taxonomy Code #2 | 2084P0800X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Healthcare Provider Taxonomy #2 | |
| Provider License Number 2 | MD60663344 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 2 | WA |
| Provider License Number State Code #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | Y |
Primary Taxonomy:
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