| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 11/22/2019 |
| Last Update Date | 08/22/2024 |
| Certification Date | 08/22/2024 |
| Medicare PECOS PAC ID | 2567875065 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518222371 PECOS PAC ID: 1153600549 Enrollment ID: I20161107001634 |
| Provider Name | Miranda Hennes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568851509 PECOS PAC ID: 4486994902 Enrollment ID: I20191231000585 |
| Provider Name | Daniel Joseph Repsold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932630639 PECOS PAC ID: 0547674673 Enrollment ID: I20210201000305 |
| Provider Name | Kathleen A Mathews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780259317 PECOS PAC ID: 1153722079 Enrollment ID: I20210630000518 |
| Provider Name | Brianna Lynn Melvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669116877 PECOS PAC ID: 4981087004 Enrollment ID: I20220822002656 |
| Provider Name | Jacqueline Kramlich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366166811 PECOS PAC ID: 1658626718 Enrollment ID: I20221201003178 |
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