| Medtriq Llc | |
|
2603 Bridgeport Way W Ste F University Place WA 98466-4724 | |
| (253) 666-6780 | |
| (253) 666-6793 |
| Full Name | Medtriq Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2603 Bridgeport Way W Ste F, University Place, Washington |
| Authorized Official Name and Position | Ajainder Shergill (OWNER) |
| Authorized Official Contact | 3603341882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medtriq Llc 9000 Crow Canyon Rd Ste S360 Danville CA 94506-1189 Ph: (360) 334-1882 | Medtriq Llc 2603 Bridgeport Way W Ste F University Place WA 98466-4724 Ph: (253) 666-6780 |
| NPI Number | 1841605524 |
|---|---|
| Provider Enumeration Date | 06/21/2014 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Medicare PECOS PAC ID | 9133348766 |
|---|---|
| Medicare Enrollment ID | O20140915000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841605524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 603397063 (Washington) | Primary |
| Provider Name | Ajainder Shergill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366648222 PECOS PAC ID: 6305991928 Enrollment ID: I20090903000513 |
| Provider Name | Karen S Rawlins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336496231 PECOS PAC ID: 5294986808 Enrollment ID: I20121107000669 |
| Provider Name | Donald Haldeman Baumer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740615749 PECOS PAC ID: 1456587583 Enrollment ID: I20131120001423 |
| Provider Name | Barbara J Frey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821212671 PECOS PAC ID: 0749244374 Enrollment ID: I20160627001924 |
| Provider Name | Liesel M K Tower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881053320 PECOS PAC ID: 7618274598 Enrollment ID: I20170918001992 |
| Provider Name | Daniel E Roa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801266119 PECOS PAC ID: 1951665918 Enrollment ID: I20180808000336 |
| Provider Name | Audry G Gorman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902828155 PECOS PAC ID: 2264759109 Enrollment ID: I20190321002787 |
| Provider Name | Kimberly Ann Cochran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811483480 PECOS PAC ID: 5092067207 Enrollment ID: I20200619002246 |
| Provider Name | Aaron C Price |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841724721 PECOS PAC ID: 9133464340 Enrollment ID: I20200723001254 |
| Provider Name | Kanwal Qidwai |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184980591 PECOS PAC ID: 2062729452 Enrollment ID: I20210422001933 |
| Provider Name | Elysia Lynn Stonem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407388465 PECOS PAC ID: 5698048460 Enrollment ID: I20210709002030 |
| Provider Name | Leeann Blattner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205334349 PECOS PAC ID: 5890159420 Enrollment ID: I20231101001064 |
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