Active NPI
Mark Mendez Vigo, MD
- Gastroenterology Physician
- Colville, WA
National Provider Identifier
1760470702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MD00023934
- Practice address
- 143 Garden Homes Dr
Colville, WA 99114-9229 - Phone
- (509) 684-3701
- Fax
- (509) 684-5817
- NPI assigned
- Oct 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | MD00023934 | WA | Primary |
Addresses
Primary practice location
143 Garden Homes Dr
Colville, WA 99114-9229
Mailing address
PO Box 421
Liberty Lake, WA 99019-0421
Phone (866) 747-2455
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50510 | Other | L&I | |
| 8105017 | Medicaid | WA | |
| 8924175 | Other | L&I CRIME VICTIMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00023934 | WA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414454400000",
"number": "1760470702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 421",
"city": "LIBERTY LAKE",
"state": "WA",
"postal_code": "990190421",
"telephone_number": "866-747-2455",
"fax_number": "509-944-9644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "143 GARDEN HOMES DR",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991149229",
"telephone_number": "509-684-3701",
"fax_number": "509-684-5817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDEZ VIGO",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-13",
"last_updated": "2014-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "WA",
"license": "MD00023934",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "50510",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8105017",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I CRIME VICTIMS",
"identifier": "8924175",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.