Hipolito Mance Custodio Iii, MD | |
945 Goethals Dr, Suite 200, Richland, WA 99352-3552 | |
(509) 942-2555 | |
(509) 942-2340 |
Full Name | Hipolito Mance Custodio Iii |
---|---|
Gender | Male |
Speciality | Obstetrics/gynecology |
Experience | 23 Years |
Location | 945 Goethals Dr, Richland, Washington |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225244379 | NPI | - | NPPES |
0249026 | Other | WA | LABOR & INDUSTRIES |
8544694 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207V00000X | Obstetrics & Gynecology | MT186614 (Pennsylvania) | Secondary |
207V00000X | Obstetrics & Gynecology | MD60074660 (Washington) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Kadlec Regional Medical Center | Richland, WA | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Kadlec Regional Medical Center | 9739098617 | 347 |
Entity Name | Kadlec Regional Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1972507580 PECOS PAC ID: 9739098617 Enrollment ID: O20031104000035 |
Mailing Address | Practice Location Address |
---|---|
Hipolito Mance Custodio Iii, MD 550 Gage Blvd, Ste 101, Richland, WA 99352-9532 Ph: (509) 942-3627 | Hipolito Mance Custodio Iii, MD 945 Goethals Dr, Suite 200, Richland, WA 99352-3552 Ph: (509) 942-2555 |
Kenton L. Sizemore, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 945 Goethals Drive, Suite 200, Richland, WA 99352 Phone: 509-942-3627 Fax: 509-942-2340 | |
Zaid Mohammed Diken, M.D. Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 969 Stevens Dr Ste 3a, Richland, WA 99352 Phone: 509-946-8696 Fax: 509-946-8646 | |
Dr. Candace C Green, M.D. Obstetrics & Gynecology Medicare: Not Enrolled in Medicare Practice Location: 2630 N Columbia Center Blvd, Suite B, Richland, WA 99352 Phone: 509-420-5053 Fax: 509-492-5537 | |
Dr. Alexis Xiaowei Tuck, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 945 Goethals Dr, Richland, WA 99352 Phone: 509-942-3095 | |
Dr. Kris Francis Kobalter, MD Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 945 Goethals Drive Suite 200, Kadlec Clinic Associated Physicians For Women, Richland, WA 99352 Phone: 509-942-3627 Fax: 509-942-2340 | |
Dr. Richard C Lorenzo Jr., D.O Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 1045 Jadwin Ave, Richland, WA 99352 Phone: 509-392-6700 Fax: 509-392-6699 |