| |
1901 So Union Allenmore Medical Center Ste A305 Tacoma WA 98405 | |
(253) 272-3031 | |
(253) 272-9449 |
Full Name | |
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Speciality | Psychiatry & Neurology |
Location | 1901 So Union, Tacoma, Washington |
Authorized Official Name and Position | John Daniel Wanwig (PHYSICIAN PRESIDENT) |
Authorized Official Contact | 2532723031 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1901 So Union Allenmore Medical Center Ste A305 Tacoma WA 98405 Ph: (253) 272-3031 | 1901 So Union Allenmore Medical Center Ste A305 Tacoma WA 98405 Ph: (253) 272-3031 |
NPI Number | 1700853983 |
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Provider Enumeration Date | 03/07/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 3173613932 |
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Medicare Enrollment ID | O20071217000375 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700853983 | NPI | - | NPPES |
1047786 | Medicaid | WA | |
1300029 | Other | MEDICAID MEDICAL | |
21793 | Other | WA | LABOR & INDUSTRIES |
8914379 | Other | CRIME VICTIMS | |
WA7229 | Other | REGENCE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 12582 (Washington) | Primary |
Provider Name | John Daniel Wanwig |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1639360936 PECOS PAC ID: 9931006533 Enrollment ID: I20031212000587 |
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