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1588663835

NPI Code Detail

MEDICARE: TED A. BRANSTETTER PA-C

MEDICARE: TED A. BRANSTETTER 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	PA10003588	WA
2	363AS0400X	Surgical Physician Assistant	10707	AZ
3	363A00000X	Physician Assistant	PA10003588	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G8871061	OTHER	WA	MEDICARE PTAN
3	G8878127	OTHER	WA	MEDICARE PTAN
4	16675551	OTHER	ID	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588663835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED A. BRANSTETTER PA-C

Provider Business Mailing Address
First Line	:	820 N CHELAN AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-2028
Country	:	US
Telephone Number	:	509-663-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N BEAVER ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3118
Country	:	US
Telephone Number	:	928-773-2332
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/16/2025

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Directions to “ TED A. BRANSTETTER PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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