MR. TIMOTHY BLACK (NPI# 1730167271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730167271 |
| Entity Type | Individual |
| Full Name | MR. TIMOTHY BLACK |
| Credential | PA |
| Practice Address |
200 Ne Mother Joseph Pl Suite 110 Vancouver WA 98664 |
| Mailing Address |
200 Ne Mother Joseph Pl Ste 210 Vancouver WA 98664-3295 |
| Practice Telephone | 3602546161 |
| Practice Fax Number | 3604491146 |
| Mailing Telephone | 3602546161 |
| Mailing Fax Number | 3604491146 |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2018-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA60650228 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
WA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528508165 | Timothy Black | Pharmacist | 322 Camino San Clemente, San Clemente, CA 92672-3704 | 2017-03-01 |
| 1700230737 | Timothy Scott Black | Social Worker | 9304 Forest Ln, Suite 161 North, Dallas, TX 75243-6238 | 2016-04-15 |
| 1437384740 | Timothy A Black | Pharmacist | 211 E Main St, Everett, PA 15537-1211 | 2009-05-16 |
| 1689830523 | Timothy Black | Counselor | 499 Cooper Landing Rd, Cherry Hill, NJ 08002-2504 | 2008-07-30 |
| 1578753091 | Timothy Roger Black | Podiatrist | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2007-07-31 |
| 1720092307 | Timothy R. Black | Physician Assistant | 709 Middle Creek Rd, Sevierville, TN 37862-5047 | 2006-07-28 |
| 1043270978 | Timothy E Black | Anesthesiology | 1500 S Dobson Road, Suite 203, Mesa, AZ 85202 | 2006-03-24 |
| 1669453940 | Timothy L Black | Surgery | 1500 Cooper St, Fort Worth, TX 76104-2710 | 2005-11-14 |
| Street Address |
200 NE MOTHER JOSEPH PL SUITE 110 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457343766 | Laura Deesha Ramme | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 410, Vancouver, WA 98664-3299 | 2005-08-22 |
| 1154874956 | Brody Kadow | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299 | 2016-07-27 |
| 1831642818 | Erik Lehrbach | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 300, Vancouver, WA 98664-3299 | 2016-07-26 |
| 1497007983 | Matthew Earnest Nipper | Clinical Exercise Physiologist | 200 Ne Mother Joseph Pl, Physicians Pavilion, Ste 400, Vancouver, WA 98664-3299 | 2012-10-08 |
| 1104187384 | James Webster | Physical Therapist | 200 Ne Mother Joseph Pl, Suite 210, Vancouver, WA 98664-3299 | 2012-06-04 |
| 1043502560 | Deven A Karvelas | Physical Medicine & Rehabilitation | 200 Ne Mother Joseph Pl, Ste 210, Vancouver, WA 98664-3299 | 2011-05-03 |
| 1588969984 | Lindsay Rae Pfender | Physician Assistant | 200 Ne Mother Joseph Pl, Ste 110, Vancouver, WA 98664-3299 | 2011-01-14 |
| 1922302942 | Janell Louise Riepma | Nurse Practitioner | 200 Ne Mother Joseph Pl, Suite 400, Vancouver, WA 98664-3299 | 2011-01-05 |
| 1285946079 | Jonathan Garrett Matthews | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 300, Vancouver, WA 98664-3299 | 2010-07-08 |
| 1649508805 | Bret Allen Lautt | Physical Therapist | 200 Ne Mother Joseph Pl, Suite 210, Vancouver, WA 98664-3299 | 2009-11-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
| Find all providers in zip 98664 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457343766 | Laura Deesha Ramme | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 410, Vancouver, WA 98664-3299 | 2005-08-22 |
| 1447720974 | Elizabeth A Eldenburg | Physician Assistant | 505 Ne 87th Ave Ste 250, Vancouver, WA 98664-1965 | 2018-11-27 |
| 1073996823 | Grace Deng | Physician Assistant | 505 Ne 87th Ave, Building A Suite 250, Vancouver, WA 98664-1989 | 2015-06-29 |
| 1164804647 | Jenny Lou Eldredge | Physician Assistant | 400 Ne Mother Joseph Place, Vancouver, WA 98664 | 2015-06-22 |
| 1194969717 | Mary-colleen D. Zucconi | Physician Assistant | 200 Ne Mother Joseph Pl Ste 110, Vancouver, WA 98664 | 2009-04-27 |
| 1982899365 | Jennifer D Hermes | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 210, Vancouver, WA 98664-3299 | 2007-09-10 |
| 1881702033 | Michael Walter Hibbs | Physician Assistant | 203 Se Park Plaza Dr, Vancouver, WA 98684-5886 | 2006-08-28 |
| 1093751703 | Kyle M. Richter | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299 | 2006-06-21 |
| 1225074990 | Bonnie L. Rosenfeld | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299 | 2006-06-21 |
| 1285670885 | Brett A. Rasmussen | Physician Assistant | 200 Ne Mother Joseph Pl, Suite 110, Vancouver, WA 98664-3299 | 2006-06-21 |
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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.