| Vm Provision Care Llc | |
|
3640 S Cedar St Ste O Tacoma WA 98409-5700 | |
| (253) 651-2498 | |
| Not Available |
| Full Name | Vm Provision Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3640 S Cedar St Ste O, Tacoma, Washington |
| Authorized Official Name and Position | Atif Mian (CEO) |
| Authorized Official Contact | 2536512498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vm Provision Care Llc Po Box 64375 Tacoma WA 98464-0375 Ph: (253) 651-2498 | Vm Provision Care Llc 3640 S Cedar St Ste O Tacoma WA 98409-5700 Ph: (253) 651-2498 |
| NPI Number | 1164072765 |
|---|---|
| Provider Enumeration Date | 09/16/2019 |
| Last Update Date | 09/16/2019 |
| Medicare PECOS PAC ID | 7911339130 |
|---|---|
| Medicare Enrollment ID | O20191108001837 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164072765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Atif M Mian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700819307 PECOS PAC ID: 7214921022 Enrollment ID: I20040414000146 |
| Provider Name | Keith C Pasternak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477567725 PECOS PAC ID: 8123048410 Enrollment ID: I20051201000345 |
| Provider Name | Amir M Aref |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063522126 PECOS PAC ID: 3971692427 Enrollment ID: I20071205000553 |
| Provider Name | Mary Jo P Cofreros |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700286440 PECOS PAC ID: 7113295890 Enrollment ID: I20170621002238 |
| Provider Name | Manh Duc Pham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518447473 PECOS PAC ID: 8820334477 Enrollment ID: I20190118000196 |
| Provider Name | Fiel Cofreros |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265832901 PECOS PAC ID: 6901337542 Enrollment ID: I20241007001416 |
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