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2737 78th Ave Se Ste 100 Mercer Island WA 98040-2843 | |
| (425) 652-4812 | |
| (425) 364-4966 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2737 78th Ave Se Ste 100, Mercer Island, Washington |
| Authorized Official Name and Position | Richard Eduardo Repass (OWNER) |
| Authorized Official Contact | 4256524812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1775 Mercer Island WA 98040-1775 Ph: (425) 652-4812 | 2737 78th Ave Se Ste 100 Mercer Island WA 98040-2843 Ph: (425) 652-4812 |
| NPI Number | 1841734035 |
|---|---|
| Provider Enumeration Date | 12/07/2016 |
| Last Update Date | 09/27/2023 |
| Certification Date | 09/27/2023 |
| Medicare PECOS PAC ID | 4284977927 |
|---|---|
| Medicare Enrollment ID | O20190520002444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841734035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Richard Repass |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316085855 PECOS PAC ID: 7719058270 Enrollment ID: I20190626000985 |
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