| Muckleshoot Indian Tribe | |
|
17500 Se 392nd St Auburn WA 98092-9705 | |
| (253) 939-6648 | |
| (253) 887-8737 |
| Full Name | Muckleshoot Indian Tribe |
|---|---|
| Speciality | Clinic/Center |
| Location | 17500 Se 392nd St, Auburn, Washington |
| Authorized Official Name and Position | Kathleen Goodwin-snyder (HEALTH MANAGER) |
| Authorized Official Contact | 2539396648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Muckleshoot Indian Tribe 17500 Se 392nd St Auburn WA 98092-9705 Ph: (253) 939-6648 | Muckleshoot Indian Tribe 17500 Se 392nd St Auburn WA 98092-9705 Ph: (253) 939-6648 |
| NPI Number | 1558448175 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 01/11/2017 |
| Medicare PECOS PAC ID | 5092724286 |
|---|---|
| Medicare Enrollment ID | O20060417000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558448175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 332800000X | Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy | (* (Not Available)) | Secondary |
| Provider Name | Jake Bergstrom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134289051 PECOS PAC ID: 5294897906 Enrollment ID: I20081215000186 |
| Provider Name | James Hampton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689621534 PECOS PAC ID: 4183811078 Enrollment ID: I20101203000842 |
| Provider Name | Steven Park |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730306374 PECOS PAC ID: 1456317619 Enrollment ID: I20170407000533 |
| Provider Name | Saritha Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013032028 PECOS PAC ID: 1557648607 Enrollment ID: I20170427002252 |
| Provider Name | Amber Postma |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1437539616 PECOS PAC ID: 6305154535 Enrollment ID: I20170508001167 |
| Provider Name | Vladimir Stovbyr |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902158249 PECOS PAC ID: 6103136650 Enrollment ID: I20170512000283 |
| Provider Name | Catherine B Wilke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336137868 PECOS PAC ID: 6103853999 Enrollment ID: I20180125001568 |
| Provider Name | Nancy A Becker |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1679582654 PECOS PAC ID: 9739177668 Enrollment ID: I20180227000731 |
| Provider Name | Judy A Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265506216 PECOS PAC ID: 9335035864 Enrollment ID: I20190122000697 |
| Provider Name | Celeste Misko |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093880445 PECOS PAC ID: 4587788898 Enrollment ID: I20190925000134 |
| Provider Name | Emily M Mcwaters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902941222 PECOS PAC ID: 4587790142 Enrollment ID: I20191107000027 |
| Provider Name | Mark Andrew Tomski |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1629187687 PECOS PAC ID: 7416906383 Enrollment ID: I20191204000747 |
| Provider Name | Douglas A Camp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548206733 PECOS PAC ID: 8325026156 Enrollment ID: I20250502002923 |
| Provider Name | Kumuda Kalyani Pradhan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831776616 PECOS PAC ID: 0941601397 Enrollment ID: I20250502003114 |
| Provider Name | Jarrett Evan Bruno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689102485 PECOS PAC ID: 0941570162 Enrollment ID: I20250507003509 |
| Provider Name | Robert W Kneller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063815496 PECOS PAC ID: 4587040225 Enrollment ID: I20250527000499 |
| Provider Name | Mythili R Ramachandran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205891181 PECOS PAC ID: 3870485493 Enrollment ID: I20250528000558 |
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