| Rodney J Koenig, PAC | |
|
2100 Powell St, Suite 920, Emeryville, CA 94608-1826 | |
| (510) 350-2600 | |
| Not Available |
| Full Name | Rodney J Koenig |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Medical |
| Location | 2100 Powell St, Emeryville, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487668505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | PA-14346 (California) | Primary |
| Entity Name | Providence Medical Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285890624 PECOS PAC ID: 8921993205 Enrollment ID: O20040216001346 |
| Mailing Address | Practice Location Address |
|---|---|
| Rodney J Koenig, PAC 6621 Darkwood Dr, Riverside, CA 92506-6528 Ph: (951) 544-1535 | Rodney J Koenig, PAC 2100 Powell St, Suite 920, Emeryville, CA 94608-1826 Ph: (510) 350-2600 |
Angela Luu, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1335 Stanford Ave, Emeryville, CA 94608 Phone: 510-647-5101 Fax: 510-647-5105 | |
Osman Wagilla, Physician Assistant Medicare: Medicare Enrolled Practice Location: 2100 Powell St, Suite 900, Emeryville, CA 94608 Phone: 510-350-2600 | |
Brandon Squibb, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2100 Powell St Ste 400, Emeryville, CA 94608 Phone: 510-350-2600 | |
Terisa Chantele Sahli, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2100 Powell St, Suite 900, Emeryville, CA 94608 Phone: 530-722-7925 | |
Mr. Will Richard Blackmon Iii, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2100 Powell St, Suite 920, Emeryville, CA 94608 Phone: 925-939-5800 | |
Joseph Robert Maloney, Physician Assistant Medicare: Medicare Enrolled Practice Location: 2100 Powell St Ste 920, Emeryville, CA 94608 Phone: 510-350-2777 | |
Mark Phillips, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1335 Stanford Ave, Emeryville, CA 94608 Phone: 510-647-5101 |