Rejuvenation Medical Pllc | |
20011 Ballinger Way Ne Shoreline WA 98155-1286 | |
(206) 407-4171 | |
(206) 906-9981 |
Full Name | Rejuvenation Medical Pllc |
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Speciality | Family Medicine |
Location | 20011 Ballinger Way Ne, Shoreline, Washington |
Authorized Official Name and Position | Joshua Kretchmar (DO) |
Authorized Official Contact | 8177892639 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Rejuvenation Medical Pllc 20011 Ballinger Way Ne Shoreline WA 98155-1286 Ph: (206) 407-4171 | Rejuvenation Medical Pllc 20011 Ballinger Way Ne Shoreline WA 98155-1286 Ph: (206) 407-4171 |
NPI Number | 1447712559 |
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Provider Enumeration Date | 04/05/2019 |
Last Update Date | 04/05/2019 |
Medicare PECOS PAC ID | 4880083062 |
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Medicare Enrollment ID | O20211109001571 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447712559 | NPI | - | NPPES |
OP60765453 | Other | WA | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Joshua B Kretchmar |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1629485701 PECOS PAC ID: 6507157575 Enrollment ID: I20171017000916 |
Provider Name | Hong-nhung T Do |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003309683 PECOS PAC ID: 2365793502 Enrollment ID: I20180926003060 |
Provider Name | Meridith Margaret Hallowell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679129431 PECOS PAC ID: 3476883505 Enrollment ID: I20191002002313 |
Provider Name | Gibril Kargbo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609386440 PECOS PAC ID: 7416214564 Enrollment ID: I20200324001967 |
Provider Name | Jong S Oh |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801433131 PECOS PAC ID: 0345635876 Enrollment ID: I20220321001476 |
Provider Name | Mario L Mata |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053057117 PECOS PAC ID: 6406220185 Enrollment ID: I20230320002476 |
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