| Prov Peds Neurology Longview | |
|
971 11th Ave Longview WA 98632-2503 | |
| (360) 577-1771 | |
| Not Available |
| Full Name | Prov Peds Neurology Longview |
|---|---|
| Speciality | Pediatrics |
| Location | 971 11th Ave, Longview, Washington |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prov Peds Neurology Longview Po Box 31001 - 4180 Pasadena CA 91110-4180 Ph: (503) 215-6494 | Prov Peds Neurology Longview 971 11th Ave Longview WA 98632-2503 Ph: (360) 577-1771 |
| NPI Number | 1104097906 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 06/20/2025 |
| Certification Date | 06/20/2025 |
| Medicare PECOS PAC ID | 0648183608 |
|---|---|
| Medicare Enrollment ID | O20080630000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104097906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 208000000X | Pediatrics | (NU) | Primary |
| Provider Name | Lian R Shaw |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154379576 PECOS PAC ID: 6002807724 Enrollment ID: I20040521000137 |
| Provider Name | William Richard Berrington |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1558374025 PECOS PAC ID: 0840271946 Enrollment ID: I20040525001604 |
| Provider Name | Damanjeet S Chugh |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366492944 PECOS PAC ID: 8224092473 Enrollment ID: I20041117000261 |
| Provider Name | Brandon N Ong |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1013968072 PECOS PAC ID: 2466405535 Enrollment ID: I20050301000473 |
| Provider Name | Ednea a Simon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174604425 PECOS PAC ID: 9335160340 Enrollment ID: I20051216000671 |
| Provider Name | Christopher S Famy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043329840 PECOS PAC ID: 7113023672 Enrollment ID: I20070501000159 |
| Provider Name | Michael J Reznicek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760568760 PECOS PAC ID: 0749389849 Enrollment ID: I20070629000304 |
| Provider Name | Sheila D Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487859708 PECOS PAC ID: 7911090519 Enrollment ID: I20070912000164 |
| Provider Name | Alicia M Ross |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1811053911 PECOS PAC ID: 4789686189 Enrollment ID: I20080212000633 |
| Provider Name | Christopher R Dale |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1700922143 PECOS PAC ID: 8224135447 Enrollment ID: I20080416000402 |
| Provider Name | Darragh S Omahony |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1730191727 PECOS PAC ID: 8820163694 Enrollment ID: I20080814000111 |
| Provider Name | Monica Marton Popovici |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437326626 PECOS PAC ID: 4385705763 Enrollment ID: I20081203000653 |
| Provider Name | Michael J Doherty |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033299953 PECOS PAC ID: 5799833075 Enrollment ID: I20090423000797 |
| Provider Name | Geoffrey M Wilson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1336185438 PECOS PAC ID: 3870493786 Enrollment ID: I20100317000310 |
| Provider Name | Jacob Abraham |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1548223381 PECOS PAC ID: 6204863541 Enrollment ID: I20100326000271 |
| Provider Name | Todd a Caulfield |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710921085 PECOS PAC ID: 4284661158 Enrollment ID: I20100326000291 |
| Provider Name | John S Pauk |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1538137385 PECOS PAC ID: 2860528445 Enrollment ID: I20100407000733 |
| Provider Name | Michael a Wilson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1871539973 PECOS PAC ID: 8325948235 Enrollment ID: I20100518000319 |
| Provider Name | Sarabjit Kaur Atwal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881928414 PECOS PAC ID: 4880888072 Enrollment ID: I20101102000188 |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548361009 PECOS PAC ID: 5395844591 Enrollment ID: I20110107000627 |
| Provider Name | Leah M Basnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235246091 PECOS PAC ID: 8527237189 Enrollment ID: I20110816000632 |
| Provider Name | Catalina Draghici |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255524930 PECOS PAC ID: 2961672704 Enrollment ID: I20110902000345 |
| Provider Name | San Sophie Wong |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1508054826 PECOS PAC ID: 3779643283 Enrollment ID: I20110927000327 |
| Provider Name | Aixa D Espinosa-morales |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851449938 PECOS PAC ID: 5092987651 Enrollment ID: I20120202000201 |
| Provider Name | James W Jordan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417156993 PECOS PAC ID: 3870675002 Enrollment ID: I20120329000427 |
| Provider Name | Hisam S Goueli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639382906 PECOS PAC ID: 3870644776 Enrollment ID: I20121030000555 |
| Provider Name | Ravi Sivasankara Menon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326160177 PECOS PAC ID: 2062572142 Enrollment ID: I20130605000091 |
| Provider Name | Benjamin Atkinson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023256237 PECOS PAC ID: 4183802945 Enrollment ID: I20130620000086 |
| Provider Name | Aaron N Stayman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477711018 PECOS PAC ID: 9133360142 Enrollment ID: I20130801000848 |
| Provider Name | Clara L Peck |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1659563526 PECOS PAC ID: 6002985264 Enrollment ID: I20130917000070 |
| Provider Name | Ruxandra M Costa |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588770093 PECOS PAC ID: 4284695024 Enrollment ID: I20131003000014 |
| Provider Name | Lori M Tam |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1306036108 PECOS PAC ID: 4981844420 Enrollment ID: I20131205000790 |
| Provider Name | Sonam T Nyatsatsang |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1821288911 PECOS PAC ID: 9739271750 Enrollment ID: I20140515002197 |
| Provider Name | Elise C Willis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1487953683 PECOS PAC ID: 6800011602 Enrollment ID: I20140711001158 |
| Provider Name | Jake Harley Choiniere |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578882452 PECOS PAC ID: 4688890155 Enrollment ID: I20140721000051 |
| Provider Name | Lesley N Bobek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922202787 PECOS PAC ID: 0244377802 Enrollment ID: I20141216000708 |
| Provider Name | Kitti Kaiboriboon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1912062035 PECOS PAC ID: 4284731027 Enrollment ID: I20150130000742 |
| Provider Name | Joshua D Remick |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1861697682 PECOS PAC ID: 2264698695 Enrollment ID: I20150501001190 |
| Provider Name | Nathaniel Lee Atkin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134358344 PECOS PAC ID: 4688828981 Enrollment ID: I20160520001449 |
| Provider Name | Logan L Vincent |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164764288 PECOS PAC ID: 4688991946 Enrollment ID: I20160621000969 |
| Provider Name | Phani Chandra Kantamneni |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1518245497 PECOS PAC ID: 0547551400 Enrollment ID: I20160623001052 |
| Provider Name | Tarvinder Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225327091 PECOS PAC ID: 0840505251 Enrollment ID: I20160817001266 |
| Provider Name | Franchette T Pascual |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245491711 PECOS PAC ID: 6305094889 Enrollment ID: I20170504000698 |
| Provider Name | Yi Mao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629327986 PECOS PAC ID: 0547538118 Enrollment ID: I20170622002818 |
| Provider Name | Joseph David Nickolas Freeburg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174898381 PECOS PAC ID: 7012224298 Enrollment ID: I20170706002670 |
| Provider Name | Natasha Sparrow |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326308339 PECOS PAC ID: 9931411600 Enrollment ID: I20170802001726 |
| Provider Name | Corey White |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154610814 PECOS PAC ID: 2961723663 Enrollment ID: I20170811001881 |
| Provider Name | Eric D Prince |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770843658 PECOS PAC ID: 2567752777 Enrollment ID: I20171002003734 |
| Provider Name | Robyn Elizabeth Nash |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043614167 PECOS PAC ID: 0244540359 Enrollment ID: I20171218003117 |
| Provider Name | Joseph Robert Perry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134354244 PECOS PAC ID: 8426285917 Enrollment ID: I20180110002318 |
| Provider Name | Abdelrahman Beltagy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013250216 PECOS PAC ID: 0840592572 Enrollment ID: I20180615002091 |
| Provider Name | Kelsey Anne Brauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376057380 PECOS PAC ID: 2365798089 Enrollment ID: I20180710002592 |
| Provider Name | Robert Willis Morse |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174555312 PECOS PAC ID: 0941192892 Enrollment ID: I20181108002544 |
| Provider Name | Meghan Rochelle Moyle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386081149 PECOS PAC ID: 5395960165 Enrollment ID: I20190826002098 |
| Provider Name | James F Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962829093 PECOS PAC ID: 7012232655 Enrollment ID: I20190910002212 |
| Provider Name | Meghan Romba |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215202361 PECOS PAC ID: 9133437528 Enrollment ID: I20190913002456 |
| Provider Name | Lien Nguyen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023402914 PECOS PAC ID: 9830404417 Enrollment ID: I20191030002908 |
| Provider Name | Preethi Balakrishnan |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1447578927 PECOS PAC ID: 7517195134 Enrollment ID: I20191114000092 |
| Provider Name | Carson Van Sanford |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669869574 PECOS PAC ID: 9537471149 Enrollment ID: I20191216000256 |
| Provider Name | Amil Rafiq |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669785804 PECOS PAC ID: 4880812452 Enrollment ID: I20191226001504 |
| Provider Name | George Lopez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578588752 PECOS PAC ID: 9638172034 Enrollment ID: I20200224000997 |
| Provider Name | Helen Z Zhang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053774000 PECOS PAC ID: 6103117619 Enrollment ID: I20200720000436 |
| Provider Name | Hanbing Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679927784 PECOS PAC ID: 3779907522 Enrollment ID: I20200727001289 |
| Provider Name | Samantha Kate Mathews-klebes |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1871977454 PECOS PAC ID: 4284982489 Enrollment ID: I20200805003078 |
| Provider Name | Kyle Y Ogami |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801276571 PECOS PAC ID: 9638471626 Enrollment ID: I20200819003829 |
| Provider Name | Michael Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20200827002834 |
| Provider Name | Derek Ting Yu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568889731 PECOS PAC ID: 5991068363 Enrollment ID: I20200903003199 |
| Provider Name | Pin-yi Ko |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356768691 PECOS PAC ID: 9436453834 Enrollment ID: I20201016001892 |
| Provider Name | William Lou |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710340161 PECOS PAC ID: 9830481241 Enrollment ID: I20210723003232 |
| Provider Name | Kevin J Woolf |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1265580054 PECOS PAC ID: 6709971112 Enrollment ID: I20220110000321 |
| Provider Name | Xiaoyan Huang |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346232857 PECOS PAC ID: 3173505633 Enrollment ID: I20220627000632 |
| Provider Name | Amin Hossein Rabiei |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770011090 PECOS PAC ID: 5698007177 Enrollment ID: I20220711001732 |
| Provider Name | Meghana Srinivas Kinariwala |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871049809 PECOS PAC ID: 4284904293 Enrollment ID: I20220726003823 |
| Provider Name | Soo Young Kwon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497199210 PECOS PAC ID: 2365686474 Enrollment ID: I20220816003257 |
| Provider Name | Lindsey K Frischmann |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629364419 PECOS PAC ID: 4789970815 Enrollment ID: I20240220002532 |
| Provider Name | Binod Wagle |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1538392659 PECOS PAC ID: 9032359369 Enrollment ID: I20240620003924 |
| Provider Name | Nicholas Stucky |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1912265190 PECOS PAC ID: 6204072671 Enrollment ID: I20241003003149 |
Lance D Brigman, MD, PS Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1004 Fir St, Longview, WA 98632 Phone: 360-423-6110 Fax: 360-423-8078 |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 |
Longview Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 820 11th Ave, Longview, WA 98632 Phone: 360-423-6626 Fax: 360-423-6626 |
Ideal Option, PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1146 14th Ave, Longview, WA 98632 Phone: 877-522-1275 Fax: 509-491-3031 |
Kidspace Therapy, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2145 Tibbetts Dr Ste A, Longview, WA 98632 Phone: 360-560-1972 Fax: 360-703-3452 |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 |