| Creekside Medical, P.s. | |
|
900 Ne 139th St Ste 202 Vancouver WA 98685-2513 | |
| (360) 566-9355 | |
| (360) 816-1327 |
| Full Name | Creekside Medical, P.s. |
|---|---|
| Speciality | Internal Medicine |
| Location | 900 Ne 139th St, Vancouver, Washington |
| Authorized Official Name and Position | Carol Davis (CLINIC MANAGER) |
| Authorized Official Contact | 3605669355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creekside Medical, P.s. 900 Ne 139th St Ste 202 Vancouver WA 98685-2513 Ph: (360) 566-9355 | Creekside Medical, P.s. 900 Ne 139th St Ste 202 Vancouver WA 98685-2513 Ph: (360) 566-9355 |
| NPI Number | 1760529374 |
|---|---|
| Provider Enumeration Date | 01/31/2007 |
| Last Update Date | 07/23/2014 |
| Medicare PECOS PAC ID | 4082683388 |
|---|---|
| Medicare Enrollment ID | O20041001000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760529374 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Washington) | Primary |
| 208000000X | Pediatrics | (Washington) | Secondary |
| 363AM0700X | Physician Assistant - Medical | (Washington) | Secondary |
| Provider Name | Supranee Nopachai |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033256581 PECOS PAC ID: 6305815606 Enrollment ID: I20041001000837 |
| Provider Name | Jill A Speaker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609913243 PECOS PAC ID: 1850360157 Enrollment ID: I20041001000862 |
| Provider Name | Olivia L Jones |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841337482 PECOS PAC ID: 6204805500 Enrollment ID: I20041001000884 |
| Provider Name | James P Roberts |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568483063 PECOS PAC ID: 8527968734 Enrollment ID: I20060921000236 |
| Provider Name | Rigoberto Acosta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912024274 PECOS PAC ID: 5799875019 Enrollment ID: I20080109000410 |
| Provider Name | Jessica T Ly |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922047356 PECOS PAC ID: 1557368529 Enrollment ID: I20080523000105 |
| Provider Name | Holly I Tse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912089947 PECOS PAC ID: 9234219304 Enrollment ID: I20120501000247 |
| Provider Name | Matthew Orlando Oxiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801031737 PECOS PAC ID: 9739238643 Enrollment ID: I20120815000479 |
| Provider Name | Maysee Dawn Salleva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326336777 PECOS PAC ID: 0345478665 Enrollment ID: I20160406001225 |
| Provider Name | Julie Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942711767 PECOS PAC ID: 0941632186 Enrollment ID: I20191108002648 |
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