MEDICARE: KIMBERLY ELIZABETH HORVATH PAC CM

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife
2	363A00000X	Physician Assistant	025211 PA10001876	WA
3	363A00000X	Physician Assistant	PA10001876	WA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	G8895789	OTHER	WA	MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0270556	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5413H0	OTHER	WA	REGENCE

NPI Number	:	1821075433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ELIZABETH HORVATH PAC CM

Provider Business Mailing Address
First Line	:	6002 WESTGATE BLVD STE 230
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98406-2572
Country	:	US
Telephone Number	:	253-761-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 WESTGATE BLVD STE 230
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98406-2572
Country	:	US
Telephone Number	:	253-761-2244
Fax Number	:

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	12/04/2020

6002 N WESTGATE BLVD , STE 230
TACOMA, WA
98406-2572

Practice Phone: 253-761-2244
Practice Fax: 253-761-1040