| Kyle Rollin Wicks, PA-C | |
|
2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | |
| (541) 677-7200 | |
| (541) 229-3309 |
| Full Name | Kyle Rollin Wicks |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 6 Years |
| Location | 2570 Nw Edenbower Blvd Ste 100, Roseburg, 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 |
|---|---|---|---|
| 1750995577 | NPI | - | NPPES |
| 500804257 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | (NU) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mercy Medical Center | Roseburg, OR | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Centennial Medical Group East Llc | 9234397878 | 63 |
| Evergreen Family Medicine Pc | 3870485139 | 55 |
| Entity Name | Centennial Medical Group East LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134436637 PECOS PAC ID: 9234397878 Enrollment ID: O20120228000510 |
| Mailing Address | Practice Location Address |
|---|---|
| Kyle Rollin Wicks, PA-C 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 Ph: (541) 677-7200 | Kyle Rollin Wicks, PA-C 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 Ph: (541) 677-7200 |
Bailey Wynn Gibbs, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2282 Nw Troost St Ste 103, Roseburg, OR 97471 Phone: 541-672-4798 |
Paul J Fieber, P.A. Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2570 Nw Edenbower Blvd, Suite 100, Roseburg, OR 97471 Phone: 541-677-7200 Fax: 541-229-3362 |
Amanda Garner, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2282 Nw Troost St Ste 103, Roseburg, OR 97471 Phone: 541-672-4798 |
Emmalee Vittetoe, Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 2700 Nw Stewart Pkwy, Roseburg, OR 97471 Phone: 541-673-0611 |
Jennifer Ann Brough Wilson, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2440 Nw Edenbower Blvd, Roseburg, OR 97471 Phone: 541-957-1141 Fax: 541-957-1466 |
Marissa Danyelle Noot, PA Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 2282 Nw Troost St Ste 103, Roseburg, OR 97471 Phone: 541-672-4798 |
Scott O Goebel, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471 Phone: 541-677-7200 Fax: 541-229-3309 |