CHAD A MONGRAIN (NPI# 1720028244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720028244 |
| Entity Type | Individual |
| Full Name | CHAD A MONGRAIN |
| Credential | DO |
| Practice Address |
100 3rd St Ste 1 Davenport WA 99122-5008 |
| Practice Telephone | 5097257501 |
| Practice Fax Number | 5097257504 |
| Mailing Telephone | 5097257501 |
| Mailing Fax Number | 5097257504 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-10-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | OP00002086 | WA | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | OP00002086 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | GROUP MEDICARE PIN | AB06402 | 01 |
| WA | 8452310 | 05 | |
| WA | 1017260 | 05 |
| Street Address |
100 3RD ST STE 1 |
| City | DAVENPORT |
| State | WA |
| Zip Code | 99122-5008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912982901 | Larry Renn Carpenter | Physician Assistant | 100 3rd St Ste 1, Davenport, WA 99122-5008 | 2005-12-13 |
| 1265917140 | Virginia Hawthorne | Nurse Practitioner | 100 3rd St Ste 1, Davenport, WA 99122-5008 | 2018-09-26 |
| 1578011789 | Tyler W. Zaugg | Physician Assistant | 100 3rd St Ste 1, Davenport, WA 99122-5008 | 2016-09-16 |
| 1053527853 | Lincoln County Hospital District 3 | Surgery | 100 3rd St Ste 1, Davenport, WA 99122-5008 | 2007-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003387697 | Creekside Pharmacy LLC | Pharmacy | 639 Morgan Street, Davenport, WA 99122 | 2018-12-08 |
| 1366959470 | Kandis Rose Paskell | Counselor | 547 Morgan Street, Davenport, WA 99122 | 2018-01-10 |
| 1538567839 | Alyssa Fleming | Speech-Language Pathologist | 28000 Prairie Springs Drive, Davenport, WA 99122 | 2014-12-18 |
| 1477742500 | Daniel W Pitman | Counselor | 1102 8th Street, Davenport, WA 99122 | 2007-10-15 |
| 1730201856 | Capstone Behavioral Health | Counselor | 49 Park Street, Davenport, WA 99122 | 2007-04-06 |
| 1972625762 | David Lee Turner | Dentist | 707 Logan St, Davenport, WA 99122 | 2007-04-04 |
| 1982723318 | Dawn Lorraine Wilcox | Counselor | 49 Park, Unit C, Davenport, WA 99122 | 2007-03-28 |
| 1184789703 | Michael G Van Pevenage | Physical Therapist | 506 Morgan Street, Davenport, WA 99122 | 2006-12-26 |
| 1447323811 | Davenport Vision Clinic, Inc. | Optometrist | 506 8th St, Davenport, WA 99122 | 2006-11-15 |
| 1912002791 | Davenport Pharmacy Inc | Pharmacy | 525 Morgan St, Davenport, WA 99122 | 2006-09-14 |
| Find all providers in zip 99122 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, 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 Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689287831 | Cynthia Marie Silva | Family Medicine | 142 Harrington Ct, Davenport, FL 33837-8986 | 2020-08-27 |
| 1467013565 | Vibrant Health, P.C. | Family Medicine | 1351 W Central Park Ave Ste 1225, Davenport, IA 52804-1889 | 2019-06-28 |
| 1831667062 | Jacqueline Bogle | Family Medicine | 1334 Oakcrest Ct, Davenport, FL 33837-1707 | 2018-11-06 |
| 1427589944 | Aubrey Riefe | Family Medicine | 4317 E 53rd St, Davenport, IA 52807-3860 | 2017-03-26 |
| 1760748644 | Marygold Lora Fernandez | Family Medicine | 2302 North Blvd W Ste D, Davenport, FL 33837-8920 | 2012-04-05 |
| 1184917981 | Linda Malizia Jager | Family Medicine | 1750 E 53rd St, Davenport, IA 52807-2707 | 2011-05-26 |
| 1881908069 | Andrew Michael Teffeau | Family Medicine | 410 Lionel Way Fl 3, Davenport, FL 33837-7809 | 2010-07-30 |
| 1740509280 | Jose Ascension Armendariz | Family Medicine | 4700 E 56th St Ste 300, Davenport, IA 52807-2904 | 2010-05-24 |
| 1336473198 | Simran Jit | Family Medicine | 3411 Spring St, Davenport, IA 52807-2114 | 2009-09-28 |
| 1184870016 | Maria Nina Concepcion Md Pa | Family Medicine | 2302 North Blvd., Suite D, Davenport, FL 33837 | 2008-08-12 |
| Find all providers in DAVENPORT | ||||
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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.