| Hazen Timothy Herzog, PHYSICIAN ASSISTANT | |
|
1900 Woodland Dr, Coos Bay, OR 97420-2045 | |
| (541) 267-5151 | |
| (541) 266-4501 |
| Full Name | Hazen Timothy Herzog |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 15 Years |
| Location | 1900 Woodland Dr, Coos Bay, Oregon |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932433190 | NPI | - | NPPES |
| 161133 | Other | OR | GROUP MEDICAID NORTH BEND MEDICAL CENTER |
| 500625533 | Medicaid | OR | |
| 74623731206 | Other | UT | LICENSE |
| P01220506 | Other | OR | RAILROAD MEDICARE |
| R000WFBTV | Other | OR | GROUP MEDICARE NORTH BEND MEDICAL CENTER |
| 1407812365 | Other | OR | GROUP NPI NORTH BEND MEDICAL CENTER |
| 93-0635514 | Other | OR | GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER |
| PA152638 | Other | OR | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 7462373-1206 (Utah) | Secondary |
| 363AS0400X | Physician Assistant - Surgical | PA152638 (Oregon) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Luke's Regional Medical Center | Boise, ID | Hospital |
| St Luke's Nampa Medical Center | Nampa, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| St Lukes Clinic-treasure Valley Llc | 4981878402 | 968 |
| Mailing Address | Practice Location Address |
|---|---|
| Hazen Timothy Herzog, PHYSICIAN ASSISTANT 1900 Woodland Dr, Coos Bay, OR 97420-2045 Ph: (541) 267-5151 | Hazen Timothy Herzog, PHYSICIAN ASSISTANT 1900 Woodland Dr, Coos Bay, OR 97420-2045 Ph: (541) 267-5151 |
Akhila Parepalli, Physician Assistant Medicare: Medicare Enrolled Practice Location: 1775 Thompson Rd, Coos Bay, OR 97420 Phone: 541-269-8111 | |
Mr. Gregory Sopka, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1900 Woodland Dr, Coos Bay, OR 97420 Phone: 541-267-5151 | |
Casey Afton Quayle, Physician Assistant Medicare: Medicare Enrolled Practice Location: 1900 Woodland Dr, Coos Bay, OR 97420 Phone: 541-267-5151 | |
Benjamin Val Chu, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1775 Thompson Rd, Coos Bay, OR 97420 Phone: 541-269-8111 | |
Clifford S Lance, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2699 N 17th St, Coos Bay, OR 97420 Phone: 541-266-3600 Fax: 541-269-0708 | |
Magdalene Clare Shaughnessy, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 1900 Woodland Dr, Coos Bay, OR 97420 Phone: 541-267-5151 | |
Matthew E Cornia, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2699 N 17th St, Coos Bay, OR 97420 Phone: 541-266-3635 Fax: 541-269-0708 |