| The Home Doctor | |
|
4901 108th St Sw Lakewood WA 98499-3724 | |
| (253) 984-7247 | |
| (253) 584-8916 |
| Full Name | The Home Doctor |
|---|---|
| Speciality | Family Medicine |
| Location | 4901 108th St Sw, Lakewood, Washington |
| Authorized Official Name and Position | Charles Plunkett (PRESIDENT) |
| Authorized Official Contact | 2539847247 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Home Doctor Po Box 98886 Lakewood WA 98496-8886 Ph: (253) 984-7247 | The Home Doctor 4901 108th St Sw Lakewood WA 98499-3724 Ph: (253) 984-7247 |
| NPI Number | 1891116109 |
|---|---|
| Provider Enumeration Date | 01/04/2014 |
| Last Update Date | 10/27/2020 |
| Medicare PECOS PAC ID | 1850292681 |
|---|---|
| Medicare Enrollment ID | O20040413001631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891116109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Victor Sobolewski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336158179 PECOS PAC ID: 5294744231 Enrollment ID: I20170201001284 |
| Provider Name | Ellen L Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538685110 PECOS PAC ID: 2769749647 Enrollment ID: I20171130003114 |
| Provider Name | Luis Eymard Javier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225409931 PECOS PAC ID: 3274833868 Enrollment ID: I20180731002005 |
| Provider Name | Mohsin Ikram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578015517 PECOS PAC ID: 1850678699 Enrollment ID: I20180809003004 |
| Provider Name | Kristyn Huffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982182788 PECOS PAC ID: 6507110764 Enrollment ID: I20181107001412 |
| Provider Name | Karen Davis Tosh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609386226 PECOS PAC ID: 4789938671 Enrollment ID: I20190114000185 |
| Provider Name | Ambreen Ahsan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124503313 PECOS PAC ID: 9537596663 Enrollment ID: I20201207002537 |
| Provider Name | Mehreen Maryam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467178319 PECOS PAC ID: 3274902150 Enrollment ID: I20221215002539 |
| Provider Name | Taimur Ikram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437832565 PECOS PAC ID: 4284098633 Enrollment ID: I20230918004117 |
| Provider Name | Hazel Rose King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558905356 PECOS PAC ID: 1850720673 Enrollment ID: I20231206000312 |
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