Ty C Gulstrom, PA- C is a
Physician Assistant physician based in Mount Vernon, Washington. Ty C Gulstrom is licensed to practice in Washington (license number PA10004348) and his current practice location is 1400 E. Kincaid Street, Mount Vernon, Washington. He can be reached at his office (for appointments etc.) via phone at
(360) 428-6434.
NPI number for Ty C Gulstrom is 1558306373 and his current mailing address is 1400 E. Kincaid Street, Attn: Credentialing, Mount Vernon, Washington. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1558306373.
Physician's Profile
| Full Name | Ty C Gulstrom |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 1400 E. Kincaid Street, Mount Vernon, Washington |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1558306373
- Provider Enumeration Date: 06/17/2006
- Last Update Date: 02/18/2015
Medical Identifiers
Medical identifiers for Ty C Gulstrom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1558306373 | NPI | - | NPPES |
| 8386484 | Medicaid | WA | |
| 3479GU | Other | WA | BSWA |
| 605960012 | Other | | USDLAB |
| 0216864 | Other | WA | LIWA |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207P00000X | Emergency Medicine | PA10004348 (Washington) | Secondary |
| 363A00000X | Physician Assistant | PA10004348 (Washington) | Primary |
| 363AM0700X | Physician Assistant - Medical | PA10004348 (Washington) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ty C Gulstrom is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ty C Gulstrom, PA- C
1400 E. Kincaid Street, Attn: Credentialing,
Mount Vernon, WA 98274-4127
Ph: (360) 428-2500 | Ty C Gulstrom, PA- C
1400 E. Kincaid Street,
Mount Vernon, WA 98274-4127
Ph: (360) 428-6434 |
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