| Tri-city Neurology, Inc. | |
|
7211 W Deschutes Ave Ste D201 Kennewick WA 99336-7715 | |
| (509) 586-5700 | |
| (509) 585-5945 |
| Full Name | Tri-city Neurology, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7211 W Deschutes Ave Ste D201, Kennewick, Washington |
| Authorized Official Name and Position | Linda M Stroben (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 5095865700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-city Neurology, Inc. 7211 W Deschutes Ave Ste D201 Kennewick WA 99336-7715 Ph: (509) 586-5700 | Tri-city Neurology, Inc. 7211 W Deschutes Ave Ste D201 Kennewick WA 99336-7715 Ph: (509) 586-5700 |
| NPI Number | 1457531303 |
|---|---|
| Provider Enumeration Date | 11/08/2007 |
| Last Update Date | 07/14/2021 |
| Certification Date | 07/14/2021 |
| Medicare PECOS PAC ID | 4789575226 |
|---|---|
| Medicare Enrollment ID | O20040323001294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457531303 | NPI | - | NPPES |
| 1116714 | Medicaid | WA | |
| 8936953 | Other | WA | L&I CRIME VICTIMS |
| 349208400 | Other | WA | FEDERAL L&I |
| 130024998 | Other | WA | RR MEDICARE |
| 160721 | Other | WA | L&I STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | MD00033734 (Washington) | Primary |
| Provider Name | Paulo J Cancado |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902891104 PECOS PAC ID: 3476444910 Enrollment ID: I20120622000126 |
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