| Conquer | |
|
809 W Main St Ste C Monroe WA 98272-2172 | |
| (206) 552-0882 | |
| (844) 440-2147 |
| Full Name | Conquer |
|---|---|
| Speciality | Clinic/Center |
| Location | 809 W Main St Ste C, Monroe, Washington |
| Authorized Official Name and Position | Jacob Grillo (CEO) |
| Authorized Official Contact | 4253871863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Conquer 809 W Main St Ste C Monroe WA 98272-2172 Ph: (206) 552-0882 | Conquer 809 W Main St Ste C Monroe WA 98272-2172 Ph: (206) 552-0882 |
| NPI Number | 1255001624 |
|---|---|
| Provider Enumeration Date | 09/17/2021 |
| Last Update Date | 10/11/2024 |
| Certification Date | 10/11/2024 |
| Medicare PECOS PAC ID | 8325562044 |
|---|---|
| Medicare Enrollment ID | O20250403002005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255001624 | NPI | - | NPPES |
| Provider Name | Calvin J Cogburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184764284 PECOS PAC ID: 1850495870 Enrollment ID: I20070402000227 |
| Provider Name | Patricia S Garcia |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659686137 PECOS PAC ID: 5092982538 Enrollment ID: I20120124000343 |
| Provider Name | Geoffrey L Godfrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689610925 PECOS PAC ID: 4486716529 Enrollment ID: I20130611000701 |
| Provider Name | Christi Dahlgren |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710302831 PECOS PAC ID: 7416171541 Enrollment ID: I20140611002034 |
| Provider Name | Thomas E Robey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942434675 PECOS PAC ID: 9032368436 Enrollment ID: I20160901000796 |
| Provider Name | Jacob Grillo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043612575 PECOS PAC ID: 8921346974 Enrollment ID: I20190216000048 |
| Provider Name | Sara E Mazzoni |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235285842 PECOS PAC ID: 0941355200 Enrollment ID: I20200709000914 |
| Provider Name | Robert E Mccullough |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386006922 PECOS PAC ID: 9335679182 Enrollment ID: I20251125000840 |
| Provider Name | Ambyr Berman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336523992 PECOS PAC ID: 9234624156 Enrollment ID: I20260429000056 |
| Provider Name | Michael R Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750858072 PECOS PAC ID: 5294204061 Enrollment ID: I20260521001029 |
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