Peacehealth Medical Group Cottage Grove | |
98 W Oregon Ave Creswell OR 97426-9259 | |
(541) 222-7700 | |
Not Available |
Full Name | Peacehealth Medical Group Cottage Grove |
---|---|
Speciality | Clinic/Center |
Location | 98 W Oregon Ave, Creswell, Oregon |
Authorized Official Name and Position | Wendy Apland (CFO) |
Authorized Official Contact | 5416863968 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Peacehealth Medical Group Cottage Grove Po Box 24410 Eugene OR 97402-0451 Ph: (360) 729-1566 | Peacehealth Medical Group Cottage Grove 98 W Oregon Ave Creswell OR 97426-9259 Ph: (541) 222-7700 |
NPI Number | 1780631267 |
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Provider Enumeration Date | 05/28/2006 |
Last Update Date | 06/04/2013 |
Medicare PECOS PAC ID | 9436060530 |
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Medicare Enrollment ID | O20040616001333 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780631267 | NPI | - | NPPES |
130008 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Erin P Reilly |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1285602086 PECOS PAC ID: 4385639277 Enrollment ID: I20040419001598 |
Provider Name | Kristi L Seidel |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780601617 PECOS PAC ID: 7012993660 Enrollment ID: I20040625000186 |
Provider Name | Wendy I Lang |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336176643 PECOS PAC ID: 5597784058 Enrollment ID: I20051115000242 |
Provider Name | Julie C Scalisi |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1396773032 PECOS PAC ID: 4486660537 Enrollment ID: I20060227000327 |
Provider Name | Michael L Moser |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1427027556 PECOS PAC ID: 3476569542 Enrollment ID: I20060227000480 |
Provider Name | Zuzanna M Wieckowska |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902823743 PECOS PAC ID: 6901802545 Enrollment ID: I20061004000635 |
Provider Name | Jonell Blase |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245391192 PECOS PAC ID: 7113020363 Enrollment ID: I20070308000688 |
Provider Name | Christopher A Calawa |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1992803944 PECOS PAC ID: 8022108679 Enrollment ID: I20071219000530 |
Provider Name | Mary E Gabriele |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912120114 PECOS PAC ID: 5092815019 Enrollment ID: I20080730000504 |
Provider Name | Arnoldo Padilla Vazquez |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1861684524 PECOS PAC ID: 4183799976 Enrollment ID: I20080813000301 |
Provider Name | Michele S Ferchau |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447414982 PECOS PAC ID: 1951462712 Enrollment ID: I20081211000596 |
Provider Name | Kenneth N Hanson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710950324 PECOS PAC ID: 0648310672 Enrollment ID: I20091222000589 |
Provider Name | Katherine L Beckstrand |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982676730 PECOS PAC ID: 7012052483 Enrollment ID: I20100310000245 |
Provider Name | William R Macmaster |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1164557054 PECOS PAC ID: 4688705130 Enrollment ID: I20100626000383 |
Provider Name | Kristy L Kironde |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679895783 PECOS PAC ID: 7618160565 Enrollment ID: I20101022001281 |
Provider Name | Thea E Petersen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1083887087 PECOS PAC ID: 0547454027 Enrollment ID: I20101028000680 |
Provider Name | Mary L Fey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134157332 PECOS PAC ID: 0345238812 Enrollment ID: I20110104001030 |
Provider Name | Juanita P Doerksen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1679546162 PECOS PAC ID: 8820278120 Enrollment ID: I20110203000349 |
Provider Name | Robert J Callahan |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1235392366 PECOS PAC ID: 8820268360 Enrollment ID: I20110819000174 |
Provider Name | Marika D Wolfe |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992966311 PECOS PAC ID: 7517139223 Enrollment ID: I20110930000203 |
Provider Name | James E Sims |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467693093 PECOS PAC ID: 8628047172 Enrollment ID: I20111123000665 |
Provider Name | Ann M Cooley |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1144485954 PECOS PAC ID: 9931356151 Enrollment ID: I20120823000210 |
Provider Name | Edgar Arturo Salazar Quiros |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1386892263 PECOS PAC ID: 1355591777 Enrollment ID: I20121022000075 |
Provider Name | Alba Virginia Schultz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801164926 PECOS PAC ID: 3173799392 Enrollment ID: I20131203001548 |
Provider Name | Jennifer L Saxer |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1336130103 PECOS PAC ID: 7911080080 Enrollment ID: I20140429000440 |
Provider Name | Rechelle L Asirot |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902118417 PECOS PAC ID: 1153546858 Enrollment ID: I20140714002492 |
Provider Name | Leon E Mccook |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609175363 PECOS PAC ID: 3779715479 Enrollment ID: I20140731002735 |
Provider Name | Sushanth Nayak |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710273958 PECOS PAC ID: 0648412627 Enrollment ID: I20140820002891 |
Provider Name | Elizabeth A Mokrohisky |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720195233 PECOS PAC ID: 9133153216 Enrollment ID: I20140905002040 |
Provider Name | Rensie Chiara R De Vera |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477846608 PECOS PAC ID: 6507094364 Enrollment ID: I20140908000565 |
Provider Name | Mary Jo A Laniewski |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1205918109 PECOS PAC ID: 9638112824 Enrollment ID: I20141103002406 |
Provider Name | Russell L Henderson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336486943 PECOS PAC ID: 8729225917 Enrollment ID: I20150130002387 |
Provider Name | Clifton J Burt |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972824043 PECOS PAC ID: 7517191232 Enrollment ID: I20150707003456 |
Provider Name | Ehsan Hazrat |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1043564586 PECOS PAC ID: 4587979844 Enrollment ID: I20150814013921 |
Provider Name | Vivekanand Pantangi |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508123183 PECOS PAC ID: 9537474739 Enrollment ID: I20150818003541 |
Provider Name | Andrea L Childress |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710211768 PECOS PAC ID: 0547308165 Enrollment ID: I20150820011704 |
Provider Name | Micah Lundstedt |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124428032 PECOS PAC ID: 3678880804 Enrollment ID: I20150921000387 |
Provider Name | Erik W Young |
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Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1891059333 PECOS PAC ID: 8325356785 Enrollment ID: I20151005000960 |
Provider Name | Julie Ann A Galinato |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477816908 PECOS PAC ID: 8224347208 Enrollment ID: I20151013001525 |
Provider Name | Sean Andrew D Orlino |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518198233 PECOS PAC ID: 4587811294 Enrollment ID: I20151211000470 |
Provider Name | John M Malleis |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1144511643 PECOS PAC ID: 7315183910 Enrollment ID: I20151223000525 |
Provider Name | Laura J Christensen |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1093176083 PECOS PAC ID: 5092013797 Enrollment ID: I20160413001403 |
Provider Name | Joshua Nicholas Plank |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1720342256 PECOS PAC ID: 7719125442 Enrollment ID: I20160505002372 |
Provider Name | Linda F Mcintyre |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437510765 PECOS PAC ID: 9335438019 Enrollment ID: I20160519001077 |
Provider Name | Marta E Hantke |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508094442 PECOS PAC ID: 7012155385 Enrollment ID: I20160527001463 |
Provider Name | Morgan C Garvin |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1558676049 PECOS PAC ID: 7911148861 Enrollment ID: I20160707002497 |
Provider Name | Rebecca Mcbride |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487044376 PECOS PAC ID: 7719208834 Enrollment ID: I20160811002731 |
Provider Name | Leda Mae T Rabot Cura |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1154515781 PECOS PAC ID: 0143530840 Enrollment ID: I20161016000003 |
Provider Name | Titus B Kosgei |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376099572 PECOS PAC ID: 9931487949 Enrollment ID: I20161026001283 |
Provider Name | Samantha M Radel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548713399 PECOS PAC ID: 0941589493 Enrollment ID: I20161128001153 |
Provider Name | Amy V Mann |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760517098 PECOS PAC ID: 6507939634 Enrollment ID: I20161130000857 |
Provider Name | Colleen Conway-edwards |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770023731 PECOS PAC ID: 8224313960 Enrollment ID: I20170321001481 |
Provider Name | Melody R Stupey |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1821022419 PECOS PAC ID: 1456364165 Enrollment ID: I20170425003169 |
Provider Name | Logan J Mcghan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689965204 PECOS PAC ID: 7113229865 Enrollment ID: I20170517000006 |
Provider Name | Angela O Loveless |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508099433 PECOS PAC ID: 8628116043 Enrollment ID: I20170526000942 |
Provider Name | Amber Vester |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1942629126 PECOS PAC ID: 9638447410 Enrollment ID: I20170620001585 |
Provider Name | Sarah Beth Flanders |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1154687606 PECOS PAC ID: 6709017080 Enrollment ID: I20170621002768 |
Provider Name | Miranda D Lanning |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1609219989 PECOS PAC ID: 6406126804 Enrollment ID: I20170718001530 |
Provider Name | Lisa M Parker |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831422336 PECOS PAC ID: 5193864395 Enrollment ID: I20170818001266 |
Provider Name | Shannon Brecik |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295279404 PECOS PAC ID: 9638451404 Enrollment ID: I20170906000923 |
Provider Name | Kathleen Rubio |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1629484472 PECOS PAC ID: 4880960012 Enrollment ID: I20171214002920 |
Provider Name | Elaine M Oleksick |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417991266 PECOS PAC ID: 5597715573 Enrollment ID: I20180104000897 |
Provider Name | Joanne M O'brien |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063507762 PECOS PAC ID: 3971591124 Enrollment ID: I20180316001655 |
Provider Name | Ashley O Schmieding |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1871972141 PECOS PAC ID: 1951666734 Enrollment ID: I20180525002175 |
Provider Name | Mark Schuchman |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1467517300 PECOS PAC ID: 2961683487 Enrollment ID: I20180531002299 |
Provider Name | Devin Lee |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790125649 PECOS PAC ID: 1052689163 Enrollment ID: I20180907000638 |
Provider Name | Sydney Marie Lefay |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1801215249 PECOS PAC ID: 7113216193 Enrollment ID: I20181029001864 |
Provider Name | Jennifer L Mitchell |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508244260 PECOS PAC ID: 6608169354 Enrollment ID: I20181107001291 |
Provider Name | Myra E Deline |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1689149361 PECOS PAC ID: 5890030993 Enrollment ID: I20181218002164 |
Provider Name | Joeann C Pansoy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679055594 PECOS PAC ID: 7911242045 Enrollment ID: I20181218003344 |
Provider Name | Mckinley M Hutchison |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760961288 PECOS PAC ID: 3779828769 Enrollment ID: I20181219002301 |
Provider Name | Marie Didario |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1740591304 PECOS PAC ID: 3678700291 Enrollment ID: I20181231001893 |
Provider Name | Kimberly R Stober |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942781489 PECOS PAC ID: 6204172414 Enrollment ID: I20190109001141 |
Provider Name | Shawn Jones |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891264974 PECOS PAC ID: 2567702285 Enrollment ID: I20190315001994 |
Provider Name | Cece A Kairos |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841669967 PECOS PAC ID: 4284943531 Enrollment ID: I20190603001637 |
Provider Name | Valeria Clarke |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1427370139 PECOS PAC ID: 8628305489 Enrollment ID: I20190816001102 |
Provider Name | Rachel L Zubko |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1578737342 PECOS PAC ID: 7012189889 Enrollment ID: I20190909003266 |
Provider Name | Shannon M Greenlee |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1558613604 PECOS PAC ID: 9739516022 Enrollment ID: I20200226001738 |
Provider Name | Inga Marie Giske |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912471228 PECOS PAC ID: 1153752621 Enrollment ID: I20200518000683 |
Provider Name | Laurel Lynne Merz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124508494 PECOS PAC ID: 8022347665 Enrollment ID: I20200817003594 |
Provider Name | Sarah D Crowe May |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1467845388 PECOS PAC ID: 8921352576 Enrollment ID: I20200914000927 |
Provider Name | Virginia Barak |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1063948461 PECOS PAC ID: 5890106298 Enrollment ID: I20201116000614 |
Provider Name | Emily M Griffith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083276307 PECOS PAC ID: 3678804176 Enrollment ID: I20210224002585 |
Provider Name | Amy Marie Keech |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1639468697 PECOS PAC ID: 0749423630 Enrollment ID: I20210512003192 |
Provider Name | Brian Mccarthy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336461813 PECOS PAC ID: 3072644228 Enrollment ID: I20210524000565 |
Provider Name | Arissa R Walberg |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1891185286 PECOS PAC ID: 2062709660 Enrollment ID: I20210723003226 |
Provider Name | Lily Mahala Cranor |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760989487 PECOS PAC ID: 0840624029 Enrollment ID: I20210817002673 |
Provider Name | Carol Lydia Wiediger |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033285242 PECOS PAC ID: 2567546773 Enrollment ID: I20220308002640 |
Provider Name | Julie Tenbrook |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164417606 PECOS PAC ID: 6709876279 Enrollment ID: I20220425002464 |
Provider Name | Reena Baharani |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1659631950 PECOS PAC ID: 5395018865 Enrollment ID: I20220803001505 |
Provider Name | Sabo Uba |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508106873 PECOS PAC ID: 4385889849 Enrollment ID: I20221003000681 |
Provider Name | Maximilian Taylor |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1699206193 PECOS PAC ID: 4284961525 Enrollment ID: I20221017001868 |
Provider Name | Audra Michelle Landry |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1770728701 PECOS PAC ID: 2062880438 Enrollment ID: I20221116002631 |
Provider Name | Desiree M Dennull |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639793995 PECOS PAC ID: 3072983675 Enrollment ID: I20221222001589 |
Provider Name | Deirdre Simpson-rhoads |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1417496316 PECOS PAC ID: 8820453814 Enrollment ID: I20230426001519 |
Provider Name | Genevieve Murstig |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1285245696 PECOS PAC ID: 1850757048 Enrollment ID: I20230512001847 |
Provider Name | Donald L Pierce |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1790197523 PECOS PAC ID: 4880811264 Enrollment ID: I20230517002436 |
Provider Name | Janette Coelho Leal |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1992090708 PECOS PAC ID: 4981844305 Enrollment ID: I20230523002747 |
Provider Name | Kodjovi Kodjo |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1780100958 PECOS PAC ID: 7517203177 Enrollment ID: I20230607001792 |
Provider Name | Bret Gorham |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1841797032 PECOS PAC ID: 3375965338 Enrollment ID: I20230616001502 |
Provider Name | Phillip Bonar |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1487271219 PECOS PAC ID: 8123494473 Enrollment ID: I20230809001826 |
Provider Name | Jose Francisco Rodriguez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669086641 PECOS PAC ID: 4183043383 Enrollment ID: I20230824002628 |
Provider Name | Yulia V Kotlyar |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1033605415 PECOS PAC ID: 9739503012 Enrollment ID: I20231004002370 |
Provider Name | Hershenta Cohen |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1619466844 PECOS PAC ID: 6204213325 Enrollment ID: I20231018001778 |
Provider Name | Nadia Swanson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902093925 PECOS PAC ID: 2860540754 Enrollment ID: I20231108001925 |
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