| Rejuvenation Medical Pllc | |
|
20011 Ballinger Way Ne Shoreline WA 98155-1286 | |
| (206) 407-4171 | |
| (206) 906-9981 |
| Full Name | Rejuvenation Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 20011 Ballinger Way Ne, Shoreline, Washington |
| Authorized Official Name and Position | Joshua Kretchmar (DO) |
| Authorized Official Contact | 8177892639 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rejuvenation Medical Pllc 20011 Ballinger Way Ne Shoreline WA 98155-1286 Ph: (206) 407-4171 | Rejuvenation Medical Pllc 20011 Ballinger Way Ne Shoreline WA 98155-1286 Ph: (206) 407-4171 |
| NPI Number | 1447712559 |
|---|---|
| Provider Enumeration Date | 04/05/2019 |
| Last Update Date | 04/05/2019 |
| Medicare PECOS PAC ID | 4880083062 |
|---|---|
| Medicare Enrollment ID | O20211109001571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447712559 | NPI | - | NPPES |
| OP60765453 | Other | WA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gerald W Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730265596 PECOS PAC ID: 3072593201 Enrollment ID: I20040720001184 |
| Provider Name | Mariena Mears |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417325093 PECOS PAC ID: 4981983491 Enrollment ID: I20161123001826 |
| Provider Name | Joshua B Kretchmar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629485701 PECOS PAC ID: 6507157575 Enrollment ID: I20171017000916 |
| Provider Name | Hong-nhung T Do |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003309683 PECOS PAC ID: 2365793502 Enrollment ID: I20180926003060 |
| Provider Name | Mary A. Gumbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962928861 PECOS PAC ID: 6800129982 Enrollment ID: I20190604002224 |
| Provider Name | Meridith Margaret Hallowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679129431 PECOS PAC ID: 3476883505 Enrollment ID: I20191002002313 |
| Provider Name | Gibril Kargbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609386440 PECOS PAC ID: 7416214564 Enrollment ID: I20200324001967 |
| Provider Name | Jong S Oh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801433131 PECOS PAC ID: 0345635876 Enrollment ID: I20220321001476 |
| Provider Name | Mario L Mata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053057117 PECOS PAC ID: 6406220185 Enrollment ID: I20230320002476 |
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