| Cowlitz Family Health Center | |
|
1057 12th Ave Longview WA 98632-2509 | |
| (360) 636-3892 | |
| (360) 414-1342 |
| Full Name | Cowlitz Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1057 12th Ave, Longview, Washington |
| Authorized Official Name and Position | James K Coffee (CEO) |
| Authorized Official Contact | 3603535803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cowlitz Family Health Center 1057 12th Ave Longview WA 98632-2509 Ph: (360) 636-3892 | Cowlitz Family Health Center 1057 12th Ave Longview WA 98632-2509 Ph: (360) 636-3892 |
| NPI Number | 1891724506 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 04/09/2024 |
| Medicare PECOS PAC ID | 5991696395 |
|---|---|
| Medicare Enrollment ID | O20040324000330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891724506 | NPI | - | NPPES |
| 5033980 | Medicaid | WA | |
| 7086523 | Medicaid | WA | |
| 7407349 | Medicaid | WA | |
| 7900426 | Medicaid | WA |
| Provider Name | Gerardo R Melgar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619903820 PECOS PAC ID: 9537176920 Enrollment ID: I20060309000300 |
| Provider Name | Stephanie G Wesztergom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497715882 PECOS PAC ID: 7719955889 Enrollment ID: I20080108000583 |
| Provider Name | Rhonda M Ramm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518118884 PECOS PAC ID: 6901968916 Enrollment ID: I20081230000338 |
| Provider Name | Tresha M Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932132552 PECOS PAC ID: 6103940234 Enrollment ID: I20100826000562 |
| Provider Name | Gail S Conway |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386669711 PECOS PAC ID: 5799809836 Enrollment ID: I20100826000753 |
| Provider Name | Seth M Mercurio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821340530 PECOS PAC ID: 1951555382 Enrollment ID: I20130211000579 |
| Provider Name | Anthony L Reyes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588877799 PECOS PAC ID: 6507051471 Enrollment ID: I20130513000083 |
| Provider Name | Sean N Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265662233 PECOS PAC ID: 5799964763 Enrollment ID: I20170126001417 |
| Provider Name | Kaelie C Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760864862 PECOS PAC ID: 6103103916 Enrollment ID: I20170504000762 |
| Provider Name | Kristie M Andreas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124308408 PECOS PAC ID: 8426375221 Enrollment ID: I20170517002088 |
| Provider Name | Brandon C Bosch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902203367 PECOS PAC ID: 6305104860 Enrollment ID: I20171211002808 |
| Provider Name | Adreia Jessop |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1972021087 PECOS PAC ID: 4183977028 Enrollment ID: I20181023003191 |
| Provider Name | Danielle R Glover-cloutier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245726694 PECOS PAC ID: 3870837180 Enrollment ID: I20181127002232 |
| Provider Name | Winnet K Katiyo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992280796 PECOS PAC ID: 8921346297 Enrollment ID: I20190212000920 |
| Provider Name | Min Kuk Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548693104 PECOS PAC ID: 2264713379 Enrollment ID: I20190829002976 |
| Provider Name | Stephanie Dianne Baxter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952965279 PECOS PAC ID: 9638500580 Enrollment ID: I20200511001344 |
| Provider Name | Laquisha Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750746152 PECOS PAC ID: 8729381769 Enrollment ID: I20210127001971 |
| Provider Name | Melissa Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205349602 PECOS PAC ID: 6103233648 Enrollment ID: I20210329001363 |
| Provider Name | Carla Delcambre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205110178 PECOS PAC ID: 9830462456 Enrollment ID: I20210525003315 |
| Provider Name | Madeline Marie Ferone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790266609 PECOS PAC ID: 5890174130 Enrollment ID: I20220616002818 |
| Provider Name | Pamela Anne Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538705322 PECOS PAC ID: 9830567429 Enrollment ID: I20221202000628 |
| Provider Name | Bethany L Madden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104691658 PECOS PAC ID: 0941659718 Enrollment ID: I20231206001121 |
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