MEDICARE: DOUGLAS C ROSSI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA10001842	WA
2	363A00000X	Physician Assistant	PA10001842	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00229060	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8901379	OTHER	WA	CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	196341	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1881638112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS C ROSSI PA-C

Provider Business Mailing Address
First Line	:	1802 YAKIMA AVE STE 102
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5303
Country	:	US
Telephone Number	:	253-272-7777
Fax Number	:	253-761-1040

Provider Business Practice Location Address
First Line	:	1802 YAKIMA AVE STE 102
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5303
Country	:	US
Telephone Number	:	253-272-7777
Fax Number	:	253-761-1040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	12/09/2020

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Directions to “ DOUGLAS C ROSSI PA-C” Practice Location

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