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903 S Adams St Ritzville WA 99169-2227 | |
| (509) 659-5402 | |
| (509) 659-1252 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 903 S Adams St, Ritzville, Washington |
| Authorized Official Name and Position | Tamra Combs (CREDENTALING) |
| Authorized Official Contact | 5096591200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
903 S Adams St Ritzville WA 99169-2227 Ph: (509) 659-5402 | 903 S Adams St Ritzville WA 99169-2227 Ph: (509) 659-5402 |
| NPI Number | 1659387041 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 01/23/2024 |
| Medicare PECOS PAC ID | 8022906122 |
|---|---|
| Medicare Enrollment ID | O20040309001448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659387041 | NPI | - | NPPES |
| 8157364 | Medicaid | WA | |
| 7105489 | Medicaid | WA | |
| 7144503 | Medicaid | WA | |
| 0050906 | Other | WA | WA L&I |
| 0148592 | Other | WA | WA L&I |
| 0156841 | Other | WA | WA L&I |
| 8119547 | Medicaid | WA | |
| 0203688 | Other | WA | WA L&I |
| 0051688 | Other | WA | WA L&I |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Lexie L Zuver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417395625 PECOS PAC ID: 1153619556 Enrollment ID: I20161018002651 |
| Provider Name | Tonya Denise Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285034629 PECOS PAC ID: 0244452829 Enrollment ID: I20220502001925 |
| Provider Name | Trent Colin Blackwill |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1922534056 PECOS PAC ID: 0042580193 Enrollment ID: I20240808003365 |
| Provider Name | Mary Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639263650 PECOS PAC ID: 7810922093 Enrollment ID: I20240910001936 |
Hometown Family Medicine Ps Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 210 W Main Ave, Ritzville, WA 99169 Phone: 509-659-4800 Fax: 509-659-4801 |