Brian Alan Mabry, BRIAN MABRY
Individual provider Active NPI Medical Physician Assistant · Pomeroy, WA
NPI 1427300052 · NPPES record last updated May 6, 2016
Key facts
- NPI
- 1427300052
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 50.003623 (OH)
- Practice address
- 66 N 6TH St
Pomeroy, WA 99347-9705 - Phone
- (509) 843-1591
- Fax
- (509) 843-1234
- NPI assigned
- Oct 5, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150930000702 | WA | Practitioner - Physician Assistant | 0941439327 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60564965 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multicare Health System | Current |
Accepting new patients | |
| Multicare Health System | Current |
Accepting new patients |
Locations
4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590
222 State Ave N
Kent, WA 98030
Phone (253) 372-7680
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 50.003623 | OH | Yes |
| Physician Assistant | 363A00000X | PA60564965 | WA |
Addresses
Primary practice location
66 N 6TH St
Pomeroy, WA 99347-9705
Mailing address
66 N 6TH St
Pomeroy, WA 99347-9705
Phone (509) 843-1591
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20358733200 | Other | OH | BWC GROUP |
| 2630700 | Medicaid | OH |
Other providers in Pomeroy, WA
- Suzanne M Grove
- Jonathan Harker
- Steven John Jackson
- Natalie Kirksey
- Janique Jade Lakey
- Joshua Levi Mayfield
- Olivia Jane Murdock
- Pomeroy Dental Center
- Pomeroy Pharmacy Inc
- Pomeroy School District
All providers in Pomeroy, WA · Medical Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.