| Palouse Pediatrics - Pullman | |
|
1205 Se Pro Mall Blvd Ste 104 Pullman WA 99163-5423 | |
| (509) 332-6139 | |
| (509) 332-6579 |
| Full Name | Palouse Pediatrics - Pullman |
|---|---|
| Speciality | Clinic/Center |
| Location | 1205 Se Pro Mall Blvd Ste 104, Pullman, Washington |
| Authorized Official Name and Position | Steven Febus (CFO) |
| Authorized Official Contact | 5093326139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Palouse Pediatrics - Pullman 840 Se Bishop Blvd Ste 101 Pullman WA 99163-5502 Ph: (509) 332-6139 | Palouse Pediatrics - Pullman 1205 Se Pro Mall Blvd Ste 104 Pullman WA 99163-5423 Ph: (509) 332-6139 |
| NPI Number | 1063646107 |
|---|---|
| Provider Enumeration Date | 05/04/2009 |
| Last Update Date | 09/20/2017 |
| Medicare PECOS PAC ID | 4183753247 |
|---|---|
| Medicare Enrollment ID | O20110111000936 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063646107 | NPI | - | NPPES |
| G8891113 | Other | WA | MEDICARE PTAN |
| 50-3922 | Other | WA | CMS CERTIFICATION |
| Provider Name | Deborah Blazzard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659639854 PECOS PAC ID: 6709002256 Enrollment ID: I20160118000146 |
| Provider Name | Methuel A V Gordon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821261728 PECOS PAC ID: 7517233075 Enrollment ID: I20171027001301 |
| Provider Name | Michael J Frostad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649253840 PECOS PAC ID: 9830386325 Enrollment ID: I20171030002747 |
| Provider Name | Lennis K Boyer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689657488 PECOS PAC ID: 4880950864 Enrollment ID: I20171107002586 |
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Pullman Readycare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 825 Se Bishop Blvd Ste 200, Pullman, WA 99163 Phone: 509-332-2517 Fax: 509-334-9247 | |
Dawnmd Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 540 E Main St Ste A, Pullman, WA 99163 Phone: 509-566-9779 |