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715 N Park Ctr # A Selah WA 98942-1174 | |
(509) 248-0497 | |
(509) 248-4167 |
Full Name | |
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Speciality | Family Medicine |
Location | 715 N Park Ctr # A, Selah, Washington |
Authorized Official Name and Position | Amelia Doris Ledbetter (DIRECTOR OF OPERATIONS) |
Authorized Official Contact | 5733354715 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1460 N 16th Ave Ste B Yakima WA 98902-7102 Ph: (509) 248-0497 | 715 N Park Ctr # A Selah WA 98942-1174 Ph: (509) 248-0497 |
NPI Number | 1851919476 |
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Provider Enumeration Date | 07/09/2020 |
Last Update Date | 09/18/2020 |
Medicare PECOS PAC ID | 3870903099 |
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Medicare Enrollment ID | O20201029000913 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851919476 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Joseph A Dimeo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1205848942 PECOS PAC ID: 1951472315 Enrollment ID: I20080612000724 |
Provider Name | Stacie R Olson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609048560 PECOS PAC ID: 8628142171 Enrollment ID: I20080801000378 |
Provider Name | Sunny J G Bhaskaran |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1144241175 PECOS PAC ID: 5698815470 Enrollment ID: I20091230000072 |
Provider Name | Anne D Tweedy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659395531 PECOS PAC ID: 0547305674 Enrollment ID: I20100301000693 |
Provider Name | Melissa Hong |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1619069911 PECOS PAC ID: 1951291038 Enrollment ID: I20100429000397 |
Provider Name | Jody B Gray |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538462197 PECOS PAC ID: 8820272347 Enrollment ID: I20110407000555 |
Provider Name | Jessica S Pechtel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1376090639 PECOS PAC ID: 4880974328 Enrollment ID: I20161129002228 |
Provider Name | Kimberly A Shipley |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083128524 PECOS PAC ID: 9537407556 Enrollment ID: I20190215001851 |
Provider Name | Kaylee L Vantrease |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558635508 PECOS PAC ID: 2264766260 Enrollment ID: I20190625002927 |
Provider Name | Jennifer Grace Wilson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972109254 PECOS PAC ID: 2365854395 Enrollment ID: I20201216002693 |
Provider Name | Brittanie K-lyn Lane |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548979164 PECOS PAC ID: 0446629638 Enrollment ID: I20221209002026 |
Frederick J Thysell Md Inc Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1416 Jesica Dr, Selah, WA 98942 Phone: 509-823-3861 Fax: 509-697-3819 | |