Excelsior Family Medicine Llc | |
3754 W Indian Trail Rd Spokane WA 99208-4700 | |
(509) 559-3100 | |
(509) 588-7437 |
Full Name | Excelsior Family Medicine Llc |
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Speciality | Family Medicine |
Location | 3754 W Indian Trail Rd, Spokane, Washington |
Authorized Official Name and Position | Andrew Richard Hill (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5095593130 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Excelsior Family Medicine Llc 3754 W Indian Trail Rd Spokane WA 99208-4700 Ph: (509) 559-3100 | Excelsior Family Medicine Llc 3754 W Indian Trail Rd Spokane WA 99208-4700 Ph: (509) 559-3100 |
NPI Number | 1275179483 |
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Provider Enumeration Date | 11/22/2019 |
Last Update Date | 08/22/2024 |
Certification Date | 08/22/2024 |
Medicare PECOS PAC ID | 2567875065 |
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Medicare Enrollment ID | O20201230000344 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275179483 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Secondary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Brian R Nelson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518222371 PECOS PAC ID: 1153600549 Enrollment ID: I20161107001634 |
Provider Name | Miranda Hennes |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568851509 PECOS PAC ID: 4486994902 Enrollment ID: I20191231000585 |
Provider Name | Daniel Joseph Repsold |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1932630639 PECOS PAC ID: 0547674673 Enrollment ID: I20210201000305 |
Provider Name | Kathleen A Mathews |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1780259317 PECOS PAC ID: 1153722079 Enrollment ID: I20210630000518 |
Provider Name | Brianna Lynn Melvin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669116877 PECOS PAC ID: 4981087004 Enrollment ID: I20220822002656 |
Provider Name | Jacqueline Kramlich |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366166811 PECOS PAC ID: 1658626718 Enrollment ID: I20221201003178 |
Provider Name | Annabeth Guzman Mcguire |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487401915 PECOS PAC ID: 1658817515 Enrollment ID: I20240726003126 |
Provider Name | Rachel Ann Felgenhauer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225876782 PECOS PAC ID: 0840737516 Enrollment ID: I20240731002229 |
Provider Name | Joel Thomas Simmons |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689431991 PECOS PAC ID: 0143755843 Enrollment ID: I20241118003432 |
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