| |
1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 | |
(360) 899-4086 | |
(360) 899-4124 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1420 Roosevelt Ave Ste 4, Mount Vernon, Washington |
Authorized Official Name and Position | Kathy Bradford (OWNER) |
Authorized Official Contact | 3607704690 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 Ph: (608) 994-0863 | 1420 Roosevelt Ave Ste 4 Mount Vernon WA 98273-2687 Ph: (360) 899-4086 |
NPI Number | 1609121854 |
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Provider Enumeration Date | 07/13/2012 |
Last Update Date | 05/07/2020 |
Medicare PECOS PAC ID | 4486800141 |
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Medicare Enrollment ID | O20120813000105 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609121854 | NPI | - | NPPES |
321303 | Other | WA | LABOR AND INDUSTRIES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Kathy Y Bradford |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871802769 PECOS PAC ID: 3173712882 Enrollment ID: I20110112000213 |
Provider Name | Marcia Rene Kucera |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003362088 PECOS PAC ID: 4587952486 Enrollment ID: I20161010000654 |
Provider Name | Anne Marie Hardy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871061606 PECOS PAC ID: 4082948419 Enrollment ID: I20190619000191 |
Provider Name | Emma Hamilton |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053075416 PECOS PAC ID: 7113377748 Enrollment ID: I20231222001538 |
Provider Name | Rhonda Eisenberg |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699423285 PECOS PAC ID: 2961852355 Enrollment ID: I20231227002713 |
Flexi-care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 E College Way, Mount Vernon, WA 98273 Phone: 360-770-2687 Fax: 855-450-1005 | |
Valley Roots Family Care Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 617 W. Division St., Mount Vernon, WA 98273 Phone: 360-428-1884 Fax: 360-428-1889 | |
Skagit Valley Medical Center Inc, Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 E Kincaid St, Mount Vernon, WA 98274 Phone: 360-428-2500 Fax: 360-428-6485 |