THE CLINIC AT PANORAMA CITY,PS (NPI# 1598982324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598982324 |
| Entity Type | Organization |
| Organization Name | THE CLINIC AT PANORAMA CITY,PS |
| Practice Address |
4044 15th Ln Se Suite A Lacey WA 98503 |
| Practice Telephone | 3604914460 |
| Practice Fax Number | 3604913090 |
| Mailing Telephone | 3604914460 |
| Mailing Fax Number | 3604913090 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DAVID L FAIRBROOK (OWNER) |
| Authorized Official Telephone | 3604914460 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| X | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| X | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4044 15TH LN SE SUITE A |
| City | LACEY |
| State | WA |
| Zip Code | 98503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700097649 | Simonetti Physical Therapy Incorporation | Specialist | 4044 15th Ln Se, Suite B, Lacey, WA 98503-6962 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
| 1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
| 1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
| 1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
| 1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
| Find all providers in zip 98503 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750921193 | Bastion Health PC | Family Medicine | 4515 Logan Dr Ne, Lacey, WA 98516-1350 | 2020-01-14 |
| 1033181003 | Robert Dewey Vandenberg | Family Medicine | 4044 15th Ave Se, Suite A, Lacey, WA 98503-6962 | 2006-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023654548 | Jared Edward Bruder | Family Medicine | 5015 S Regal St Apt B2014, Spokane, WA 99223-7906 | 2019-11-19 |
| 1699010314 | Association of University Physicians | Family Medicine | 325 9th Ave E, Hmc Senior Care Clinic, Seattle, WA 98104-2420 | 2012-12-06 |
| 1346570728 | Scott Andrew Balson | Family Medicine | 1901 S Union Ave # 244, Tacoma, WA 98405-1702 | 2010-01-06 |
| 1992953277 | Gary Eugene Gaffield | Family Medicine | 44416 Dalles Rd, Concrete, WA 98237-9431 | 2008-08-28 |
| 1245380468 | Assadullah Kazemi | Family Medicine | 4515 Mlk Way, Providence Elderplace, Seattle, WA 98108 | 2007-01-11 |
| 1063577039 | Troyer Eric J H Md | Family Medicine | 7728 12th Ave Nw, Seattle, WA 98117-4135 | 2006-12-27 |
| 1205907789 | Marcus E Kuypers Md PC | Family Medicine | 104 S First, Suite B, La Conner, WA 98257-0840 | 2006-11-13 |
| 1760553028 | Laurie J Mercier Md Ps | Family Medicine | 13553 Ne 54th Pl, Bellevue, WA 98005-1037 | 2006-11-10 |
| 1861572737 | Suzanne Heidi Sample Staudinger | Family Medicine | 10803 S Freya Rd, Spokane, WA 99223-9417 | 2006-10-16 |
| 1124116611 | Bruce Howard Dentler | Family Medicine | 1010 W Rosewood Ave, Spokane, WA 99208-4257 | 2006-10-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.