Stan W Pniewski, MD – Diagnostic Radiology Physician

Key facts

NPI: 1124054036
Entity type: Individual (NPI type 1)
Primary specialty: Diagnostic Radiology Physician 2085R0202X
License: MD00038267 (WA)
Practice address: 800 Alder St
South Bend, WA 98586
Phone: (360) 642-3181
NPI assigned: Jun 23, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Public Hospital District 3 of Pacific County Critical Access Hospital · Ilwaco, WA · NPI 1295771376

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Public Hospital District 3 of Pacific County		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Diagnostic Radiology Physician	2085R0202X	MD00038267	WA	Yes

Addresses

Primary practice location

800 Alder St
South Bend, WA 98586

Mailing address

PO Box 2450
Corvallis, OR 97339-2450
Phone (541) 758-5047

Other identifiers

Identifier	Type	State	Issuer
1111152	Medicaid	WA

Other providers in South Bend, WA

All providers in South Bend, WA · Diagnostic Radiology Physician in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.