Sang-joon Park (NPI# 1215373238, PAC ID# 5193005767) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PSYCHIATRY.
| Nation Provider ID (NPI) | 1215373238 |
| PAC ID by PECOS | 5193005767 |
| Professional Enrollment ID | I20170804000319 |
| Full Name | Sang-joon Park |
| Organization Legal Name | PROVIDENCE HEALTH ALLIANCE |
| Address |
301 Londonderry Dr Waco TX 76712-7915 |
| Phone Number | 2547765970 |
| Gender | M |
| Medical School | TEXAS A & M UNIVERSITY COLLEGE OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | PSYCHIATRY |
| Group Practice PAC ID | 6305731068 |
| Number of Group Practice Members | 121 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 301 Londonderry Dr, Waco, TX 76712-7915 | 2547765970 | PROVIDENCE HEALTH ALLIANCE |
| Organization Legal Name | PROVIDENCE HEALTH ALLIANCE |
| Physicians | 117 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Adel Nasser | Physician Assistant | Providence Health Alliance | 600 Franklin Ave, Suite B C, Waco, TX 76701-0002 |
| Heather Branch | Nurse Practitioner | Providence Health Alliance | 7104 New Sanger Rd, Providence Family Medicine, Waco, TX 76712-3928 |
| David Glen Morris | Physician Assistant | Providence Health Alliance | 305 Londonderry Dr, Waco, TX 76712-7929 |
| Matthew T Pattillo | Pulmonary Disease | Providence Health Alliance | 340 Richland W Cir, Waco Lung Associates, Waco, TX 76712-7919 |
| William H Turney | General Surgery | Providence Health Alliance | 6600 Fish Pond Rd, Waco, TX 76710-2582 |
| Eric Chudej | Family Medicine | Providence Health Alliance | 1401 Jane Ln, West, TX 76691-1013 |
| Chad S Conner | Orthopedic Surgery | Providence Health Alliance | 7125 Sanger Rd, Suite 516, Waco, TX 76712-4054 |
| Colin R Bailey | Family Medicine | Providence Health Alliance | 2100 Lake Shore Dr, Waco, TX 76708-1271 |
| John B Shelton | Family Medicine | Providence Health Alliance | 6101 Woodway Dr, 200 Providence Family Health Clinic, Waco, TX 76712-6117 |
| Scott E Blattman | Family Medicine | Providence Health Alliance | 301 Richland W Cir, Providence Internal Medicine Clinic, Waco, TX 76712-7932 |
| Street Address |
301 LONDONDERRY DR |
| City | WACO |
| State | TX |
| Zip | 76712-7915 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Greg D Blaisdell | Psychiatry | Providence Health Alliance | 301 Londonderry Dr, Waco, TX 76712-7915 |
| Aurora M Mignosa | Psychiatry | Providence Health Alliance | 301 Londonderry Dr, Waco, TX 76712-7915 |
| Joshua J Warren | Psychiatry | Providence Health Alliance | 301 Londonderry Dr, Waco, TX 76712-7915 |
| Cody Mcmahan | Psychiatry | Providence Health Alliance | 301 Londonderry Dr, Waco, TX 76712-7915 |
| Frances E Koller | Psychiatry | Providence Health Alliance | 301 Londonderry Dr, Waco, TX 76712-7915 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ntiense Covey | Clinical Social Worker | 200 W Hwy 6, Suite 217, Waco, TX 76712 | |
| Todd Moffatt | General Surgery | 1000 W Hwy 6, Suite 410, Waco, TX 76712 | |
| Eric F Oneill | Plastic and Reconstructive Surgery | 1000 W Hwy 6, Suite 500, Waco, TX 76712 | |
| Lute George Oas | Radiation Oncology | Texas Oncology Pa | 1700 W Hwy 6, Waco, TX 76712-2452 |
| Justin Wylie Wray | Radiation Oncology | Texas Oncology Pa | 1700 W Hwy 6, Waco, TX 76712-2452 |
| David J Schickner | Neurosurgery | David J. Schickner, M.d., P.a. | 6901 Medical Pkwy, Waco, TX 76712-2589 |
| Charles W Guy | Plastic and Reconstructive Surgery | 101 Burnett Ct, Suite B, Waco, TX 76712-3100 | |
| Mark A Antonacci | Emergency Medicine | Premier Physicians - II Pa | 9110 Jordan Ln, Suite 200, Woodway, TX 76712-3369 |
| Nina Wilson | Nurse Practitioner | Premier Physicians - II Pa | 9110 Jordan Ln, Suite 200, Woodway, TX 76712-3369 |
| Travis Gene Volcik | Nurse Practitioner | Premier Physicians - II Pa | 9110 Jordan Ln, Suite 200, Woodway, TX 76712-3369 |
| Find all physicians in zip 76712 | |||
| City | WACO |
| Zip Code | 76712 |
| Specialty | PSYCHIATRY |
| City + Specialty | WACO + PSYCHIATRY |
Please comment or provide details below to improve the information on Sang-joon Park.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.