| Impact Physician Group, Washington Llc | |
|
2805 Ne 129th St Vancouver WA 98686-3324 | |
| (360) 356-1890 | |
| Not Available |
| Full Name | Impact Physician Group, Washington Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2805 Ne 129th St, Vancouver, Washington |
| Authorized Official Name and Position | Paul Miller (CEO) |
| Authorized Official Contact | 6789675599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Physician Group, Washington Llc 21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 Ph: (678) 967-5599 | Impact Physician Group, Washington Llc 2805 Ne 129th St Vancouver WA 98686-3324 Ph: (360) 356-1890 |
| NPI Number | 1457008971 |
|---|---|
| Provider Enumeration Date | 03/04/2022 |
| Last Update Date | 03/04/2022 |
| Medicare PECOS PAC ID | 7315333838 |
|---|---|
| Medicare Enrollment ID | O20220411001301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457008971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jibran K Durrani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750797262 PECOS PAC ID: 8527378850 Enrollment ID: I20220110001045 |
| Provider Name | Zubair Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134416019 PECOS PAC ID: 0840410403 Enrollment ID: I20220110002602 |
| Provider Name | Ravinderpal Nandra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639358427 PECOS PAC ID: 7911052162 Enrollment ID: I20220110002610 |
| Provider Name | Muhammad Farhan Khaliq |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790168409 PECOS PAC ID: 0244546331 Enrollment ID: I20230419000662 |
| Provider Name | Richard Beach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558858092 PECOS PAC ID: 8921402405 Enrollment ID: I20240226003780 |
| Provider Name | Danish Mirza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184005332 PECOS PAC ID: 7517218118 Enrollment ID: I20240301001794 |
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