| Prov Peds Neurology Longview | |
|
971 11th Ave Longview WA 98632-2503 | |
| (360) 577-1771 | |
| Not Available |
| Full Name | Prov Peds Neurology Longview |
|---|---|
| Speciality | Clinic/Center |
| Location | 971 11th Ave, Longview, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST CORP SEC FOR ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prov Peds Neurology Longview Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Prov Peds Neurology Longview 971 11th Ave Longview WA 98632-2503 Ph: (360) 577-1771 |
| NPI Number | 1104097906 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 11/13/2018 |
| Medicare PECOS PAC ID | 0648183608 |
|---|---|
| Medicare Enrollment ID | O20080630000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104097906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lian R Shaw |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154379576 PECOS PAC ID: 6002807724 Enrollment ID: I20040521000137 |
| Provider Name | Denise M Janetos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467497073 PECOS PAC ID: 9335121672 Enrollment ID: I20040602000363 |
| Provider Name | Damanjeet S Chugh |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366492944 PECOS PAC ID: 8224092473 Enrollment ID: I20041117000261 |
| Provider Name | Hanny A Tan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881770501 PECOS PAC ID: 7315998077 Enrollment ID: I20050210000085 |
| Provider Name | Brandon N Ong |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1013968072 PECOS PAC ID: 2466405535 Enrollment ID: I20050301000473 |
| Provider Name | Lisa K Holbrook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083647762 PECOS PAC ID: 2264459775 Enrollment ID: I20051024001063 |
| Provider Name | Ednea A Simon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174604425 PECOS PAC ID: 9335160340 Enrollment ID: I20051216000671 |
| Provider Name | Yahn Kun Chiou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932296084 PECOS PAC ID: 2163418419 Enrollment ID: I20060403000101 |
| Provider Name | Anne-marie B Mccoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720085475 PECOS PAC ID: 2567465495 Enrollment ID: I20060816000038 |
| Provider Name | Richard Derrick Knowles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225113236 PECOS PAC ID: 8820062656 Enrollment ID: I20070201000227 |
| Provider Name | Christopher S Famy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043329840 PECOS PAC ID: 7113023672 Enrollment ID: I20070501000159 |
| Provider Name | Michael J Reznicek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760568760 PECOS PAC ID: 0749389849 Enrollment ID: I20070629000304 |
| Provider Name | Sheila D Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487859708 PECOS PAC ID: 7911090519 Enrollment ID: I20070912000164 |
| Provider Name | Arpan Waghray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801088794 PECOS PAC ID: 5597847459 Enrollment ID: I20080130000729 |
| Provider Name | Alicia M Ross |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1811053911 PECOS PAC ID: 4789686189 Enrollment ID: I20080212000633 |
| Provider Name | Christopher M Berberian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710185087 PECOS PAC ID: 0244322022 Enrollment ID: I20080716000661 |
| Provider Name | Monica Marton Popovici |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437326626 PECOS PAC ID: 4385705763 Enrollment ID: I20081203000653 |
| Provider Name | Michael J Doherty |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033299953 PECOS PAC ID: 5799833075 Enrollment ID: I20090423000797 |
| Provider Name | Sheryll L Rosario |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811192131 PECOS PAC ID: 9537213517 Enrollment ID: I20090811000561 |
| Provider Name | Amanda C Kerber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265670129 PECOS PAC ID: 9032258926 Enrollment ID: I20091207000280 |
| Provider Name | Tracy Woodson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922112051 PECOS PAC ID: 8921184714 Enrollment ID: I20100107000084 |
| Provider Name | Geoffrey M Wilson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1336185438 PECOS PAC ID: 3870493786 Enrollment ID: I20100317000310 |
| Provider Name | Tyler Justin Gluckman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1790749422 PECOS PAC ID: 2466464862 Enrollment ID: I20100317000483 |
| Provider Name | James G Beckerman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487697488 PECOS PAC ID: 4789630385 Enrollment ID: I20100322000921 |
| Provider Name | Ethan Korngold |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1568452738 PECOS PAC ID: 0345248464 Enrollment ID: I20100325000748 |
| Provider Name | Jacob Abraham |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1548223381 PECOS PAC ID: 6204863541 Enrollment ID: I20100326000271 |
| Provider Name | Todd A Caulfield |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710921085 PECOS PAC ID: 4284661158 Enrollment ID: I20100326000291 |
| Provider Name | Craig R Walsh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922047935 PECOS PAC ID: 5193752061 Enrollment ID: I20100326000354 |
| Provider Name | Michael A Wilson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1871539973 PECOS PAC ID: 8325948235 Enrollment ID: I20100518000319 |
| Provider Name | Sarabjit Kaur Atwal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881928414 PECOS PAC ID: 4880888072 Enrollment ID: I20101102000188 |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548361009 PECOS PAC ID: 5395844591 Enrollment ID: I20110107000627 |
| Provider Name | Kristin B Legrand |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760643886 PECOS PAC ID: 0244410439 Enrollment ID: I20110204000447 |
| Provider Name | Heidi L Kjos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124015433 PECOS PAC ID: 6103007646 Enrollment ID: I20110216001044 |
| Provider Name | Tracy W Sax |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487647624 PECOS PAC ID: 2567358088 Enrollment ID: I20110512000851 |
| Provider Name | Catalina M Draghici |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255524930 PECOS PAC ID: 2961672704 Enrollment ID: I20110902000345 |
| Provider Name | Aixa D Espinosa-morales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851449938 PECOS PAC ID: 5092987651 Enrollment ID: I20120202000201 |
| Provider Name | James W Jordan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417156993 PECOS PAC ID: 3870675002 Enrollment ID: I20120329000427 |
| Provider Name | Cara D Ellis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639303944 PECOS PAC ID: 7911155312 Enrollment ID: I20120925000843 |
| Provider Name | Hisam S Goueli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639382906 PECOS PAC ID: 3870644776 Enrollment ID: I20121030000555 |
| Provider Name | Robert Quintos |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750324653 PECOS PAC ID: 5890737886 Enrollment ID: I20121113000617 |
| Provider Name | Ravi Sivasankara Menon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326160177 PECOS PAC ID: 2062572142 Enrollment ID: I20130605000091 |
| Provider Name | Benjamin Atkinson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023256237 PECOS PAC ID: 4183802945 Enrollment ID: I20130620000086 |
| Provider Name | Clara L Peck |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659563526 PECOS PAC ID: 6002985264 Enrollment ID: I20130917000070 |
| Provider Name | Lori M Tam |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1306036108 PECOS PAC ID: 4981844420 Enrollment ID: I20131205000790 |
| Provider Name | Kimberly S Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578870069 PECOS PAC ID: 3476781055 Enrollment ID: I20140103000669 |
| Provider Name | Jon M Hartinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982850483 PECOS PAC ID: 2163693367 Enrollment ID: I20140630001144 |
| Provider Name | Elise C Willis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1487953683 PECOS PAC ID: 6800011602 Enrollment ID: I20140711001158 |
| Provider Name | Jake Harley Choiniere |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578882452 PECOS PAC ID: 4688890155 Enrollment ID: I20140721000051 |
| Provider Name | Kristin K Loch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730197294 PECOS PAC ID: 1850377102 Enrollment ID: I20141201001540 |
| Provider Name | Lesley N Bobek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922202787 PECOS PAC ID: 0244377802 Enrollment ID: I20141216000708 |
| Provider Name | Kitti Kaiboriboon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1912062035 PECOS PAC ID: 4284731027 Enrollment ID: I20150130000742 |
| Provider Name | Joshua D Remick |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1861697682 PECOS PAC ID: 2264698695 Enrollment ID: I20150501001190 |
| Provider Name | Jamie L Dailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841434990 PECOS PAC ID: 6709021561 Enrollment ID: I20151008001978 |
| Provider Name | Pia Klamper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467708800 PECOS PAC ID: 6901053800 Enrollment ID: I20151016001108 |
| Provider Name | Sareena D Oncea |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1609207406 PECOS PAC ID: 6608179353 Enrollment ID: I20160129001411 |
| Provider Name | Sekou C Ford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538138276 PECOS PAC ID: 3476700956 Enrollment ID: I20160426002085 |
| Provider Name | Nathaniel Lee Atkin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134358344 PECOS PAC ID: 4688828981 Enrollment ID: I20160520001449 |
| Provider Name | Logan L Vincent |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164764288 PECOS PAC ID: 4688991946 Enrollment ID: I20160621000969 |
| Provider Name | Manvi V Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346694403 PECOS PAC ID: 7517250525 Enrollment ID: I20160728001898 |
| Provider Name | Tarvinder Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225327091 PECOS PAC ID: 0840505251 Enrollment ID: I20160817001266 |
| Provider Name | Laurie Chern |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457385114 PECOS PAC ID: 6204961311 Enrollment ID: I20161017002364 |
| Provider Name | Kelsey Susan Alama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598137424 PECOS PAC ID: 5991083693 Enrollment ID: I20161101001052 |
| Provider Name | Franchette T Pascual |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245491711 PECOS PAC ID: 6305094889 Enrollment ID: I20170504000698 |
| Provider Name | Yi Mao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629327986 PECOS PAC ID: 0547538118 Enrollment ID: I20170622002818 |
| Provider Name | Joseph David Nickolas Freeburg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174898381 PECOS PAC ID: 7012224298 Enrollment ID: I20170706002670 |
| Provider Name | Laura M Keels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619925286 PECOS PAC ID: 5698851517 Enrollment ID: I20170718003642 |
| Provider Name | Natasha Sparrow |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326308339 PECOS PAC ID: 9931411600 Enrollment ID: I20170802001726 |
| Provider Name | Corey White |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154610814 PECOS PAC ID: 2961723663 Enrollment ID: I20170811001881 |
| Provider Name | Eric D Prince |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770843658 PECOS PAC ID: 2567752777 Enrollment ID: I20171002003734 |
| Provider Name | Christine B Green |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497097570 PECOS PAC ID: 2466728415 Enrollment ID: I20171019001430 |
| Provider Name | Joseph Robert Perry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134354244 PECOS PAC ID: 8426285917 Enrollment ID: I20180110002318 |
| Provider Name | Shushaun B Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891101671 PECOS PAC ID: 6608096433 Enrollment ID: I20180130001541 |
| Provider Name | Monique Gedenk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740226745 PECOS PAC ID: 4385627538 Enrollment ID: I20180410002793 |
| Provider Name | Abdelrahman Beltagy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013250216 PECOS PAC ID: 0840592572 Enrollment ID: I20180615002091 |
| Provider Name | Mary Thompson Pierce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326256959 PECOS PAC ID: 7719235662 Enrollment ID: I20180809001093 |
| Provider Name | Robert Willis Morse |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174555312 PECOS PAC ID: 0941192892 Enrollment ID: I20181108002544 |
| Provider Name | Karin S Lloyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891128906 PECOS PAC ID: 3072897313 Enrollment ID: I20190329001132 |
| Provider Name | Matthew Mackinnon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780071415 PECOS PAC ID: 7719299437 Enrollment ID: I20190816003179 |
| Provider Name | Meghan Rochelle Moyle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386081149 PECOS PAC ID: 5395960165 Enrollment ID: I20190826002098 |
| Provider Name | James F Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962829093 PECOS PAC ID: 7012232655 Enrollment ID: I20190910002212 |
| Provider Name | Zheru Li |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578718755 PECOS PAC ID: 1254488422 Enrollment ID: I20191010002279 |
| Provider Name | Carson Van Sanford |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669869574 PECOS PAC ID: 9537471149 Enrollment ID: I20191216000256 |
| Provider Name | Amil Rafiq |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669785804 PECOS PAC ID: 4880812452 Enrollment ID: I20191226001504 |
| Provider Name | Andy Humes |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1730267220 PECOS PAC ID: 8921906066 Enrollment ID: I20200123001995 |
| Provider Name | George Lopez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578588752 PECOS PAC ID: 9638172034 Enrollment ID: I20200224000997 |
| Provider Name | Joseph E Marcil |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780101949 PECOS PAC ID: 0648544668 Enrollment ID: I20200618002175 |
| Provider Name | Helen Z Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053774000 PECOS PAC ID: 6103117619 Enrollment ID: I20200720000436 |
| Provider Name | Hanbing Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679927784 PECOS PAC ID: 3779907522 Enrollment ID: I20200727001289 |
| Provider Name | Kyle Yuichi Ogami |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801276571 PECOS PAC ID: 9638471626 Enrollment ID: I20200819003829 |
| Provider Name | Michael Meng Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20200827002834 |
| Provider Name | Derek Ting Yu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568889731 PECOS PAC ID: 5991068363 Enrollment ID: I20200903003199 |
| Provider Name | Rebecca Ann Madore |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1336389246 PECOS PAC ID: 6204255151 Enrollment ID: I20200928000863 |
| Provider Name | James T Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700373305 PECOS PAC ID: 8527319656 Enrollment ID: I20210125003038 |
| Provider Name | Alison L Clarke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760831051 PECOS PAC ID: 1557792884 Enrollment ID: I20210212002386 |
| Provider Name | Maureen A Sprague |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1578654059 PECOS PAC ID: 6709972698 Enrollment ID: I20210318001344 |
| Provider Name | Alena Y Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003107582 PECOS PAC ID: 6002216579 Enrollment ID: I20210621002793 |
| Provider Name | William Lou |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710340161 PECOS PAC ID: 9830481241 Enrollment ID: I20210723003232 |
| Provider Name | Megan J Barton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265666549 PECOS PAC ID: 6901934181 Enrollment ID: I20210826001744 |
| Provider Name | Elena D Deweese |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508531823 PECOS PAC ID: 3971900333 Enrollment ID: I20210928000864 |
| Provider Name | Gavin Klumpp |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1457923294 PECOS PAC ID: 7719385434 Enrollment ID: I20211012000052 |
| Provider Name | Kelsey J Peck |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003482787 PECOS PAC ID: 0648678995 Enrollment ID: I20211018001364 |
| Provider Name | Carmen G Kendall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780639575 PECOS PAC ID: 3577515261 Enrollment ID: I20211027000323 |
| Provider Name | Carolyn R Meisner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861074965 PECOS PAC ID: 3274942784 Enrollment ID: I20211113000264 |
| Provider Name | Linh D Dao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518997584 PECOS PAC ID: 9537296751 Enrollment ID: I20211129002242 |
| Provider Name | Dustin P Montgomery |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407138340 PECOS PAC ID: 5496928483 Enrollment ID: I20220105002848 |
| Provider Name | Kevin J Woolf |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1265580054 PECOS PAC ID: 6709971112 Enrollment ID: I20220110000321 |
| Provider Name | Jessica L Semaan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205353364 PECOS PAC ID: 4385903830 Enrollment ID: I20220324000885 |
| Provider Name | Elise J Mahoney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790054831 PECOS PAC ID: 9032379193 Enrollment ID: I20220408001915 |
| Provider Name | Kimberly J Wehbe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477586097 PECOS PAC ID: 8628051778 Enrollment ID: I20220411000885 |
| Provider Name | Clarice A Cheng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205072956 PECOS PAC ID: 6406904796 Enrollment ID: I20220411000960 |
| Provider Name | David G Silvestre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831153196 PECOS PAC ID: 0648286062 Enrollment ID: I20220418001052 |
| Provider Name | Nicole R Benthin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407400500 PECOS PAC ID: 0941530869 Enrollment ID: I20220517002015 |
| Provider Name | Xiaoyan Huang |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346232857 PECOS PAC ID: 3173505633 Enrollment ID: I20220627000632 |
| Provider Name | Amin Hossein Rabiei |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770011090 PECOS PAC ID: 5698007177 Enrollment ID: I20220711001732 |
| Provider Name | Vincent R Quintos |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770928228 PECOS PAC ID: 3971740952 Enrollment ID: I20220727003367 |
| Provider Name | Robin Y Grattan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205951530 PECOS PAC ID: 0042371973 Enrollment ID: I20220728003673 |
| Provider Name | Soo Young Kwon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497199210 PECOS PAC ID: 2365686474 Enrollment ID: I20220816003257 |
| Provider Name | Fang-yu Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255998324 PECOS PAC ID: 8729414347 Enrollment ID: I20220902002678 |
| Provider Name | Amanda Mcconaughey |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023741303 PECOS PAC ID: 6204212418 Enrollment ID: I20220926001413 |
| Provider Name | Kathy Y Bordeaux |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467171298 PECOS PAC ID: 8325424559 Enrollment ID: I20220926002266 |
| Provider Name | Jennifer Marie Kurotobi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1578047858 PECOS PAC ID: 9830567957 Enrollment ID: I20221122000484 |
| Provider Name | Joanna Chadd |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982193983 PECOS PAC ID: 2961757737 Enrollment ID: I20221208001205 |
| Provider Name | Angela M Vitek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841797990 PECOS PAC ID: 9436414919 Enrollment ID: I20230111000622 |
| Provider Name | Caleb P Prentice |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700231347 PECOS PAC ID: 2668738642 Enrollment ID: I20230814001520 |
| Provider Name | Mark A Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598781684 PECOS PAC ID: 2062495294 Enrollment ID: I20230915002265 |
| Provider Name | Melinda C Burns-williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710351341 PECOS PAC ID: 1456658327 Enrollment ID: I20230926002997 |
| Provider Name | Miranda V Keepers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285010181 PECOS PAC ID: 6204280167 Enrollment ID: I20230927002225 |
| Provider Name | Yue Wang |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710695929 PECOS PAC ID: 4688043136 Enrollment ID: I20231010003742 |
| Provider Name | Jenean Lynn Harris |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1720366537 PECOS PAC ID: 6103273420 Enrollment ID: I20231108001965 |
| Provider Name | Lisa F Chin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043519747 PECOS PAC ID: 3779618582 Enrollment ID: I20231121003045 |
| Provider Name | Janice P Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194803718 PECOS PAC ID: 3678594785 Enrollment ID: I20231129000397 |
| Provider Name | Chenyong Xiang |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114655636 PECOS PAC ID: 9436535861 Enrollment ID: I20231130003211 |
| Provider Name | Lindsey K Frischmann |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629364419 PECOS PAC ID: 4789970815 Enrollment ID: I20240220002532 |
Lance D Brigman, Md, Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1004 Fir St, Longview, WA 98632 Phone: 360-423-6110 Fax: 360-423-8078 | |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 | |
Longview Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 820 11th Ave, Longview, WA 98632 Phone: 360-423-6626 Fax: 360-423-6626 | |
Ideal Option, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1146 14th Ave, Longview, WA 98632 Phone: 877-522-1275 Fax: 509-491-3031 | |
Kidspace Therapy, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2145 Tibbetts Dr Ste A, Longview, WA 98632 Phone: 360-560-1972 Fax: 360-703-3452 | |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 |