LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. (NPI# 1487122339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487122339 |
| Entity Type | Organization |
| Organization Name | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. |
| Practice Address |
11820 Ne Crestwood Dr Ste 100 Vancouver WA 98684-5103 |
| Mailing Address |
218 N I St Lompoc CA 93436-0909 |
| Practice Telephone | 8052643388 |
| Mailing Telephone | 8052643388 |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2019-01-25 |
| Authorized Official Name | AMY DAMATO (CONTRACTS DIRECTOR) |
| Authorized Official Telephone | 8052643388 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5324 84th St E Ste D, Tacoma, WA 984465627 | 8052643388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912460874 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 5701 21st Ave W Ste 3, Bradenton, FL 34209-5605 | 2019-04-08 |
| 1174084578 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 802 Iowa Ave, Los Banos, CA 93635-3450 | 2019-03-28 |
| 1083175483 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 777 S Ham Ln Ste G, Lodi, CA 95242-3593 | 2019-03-28 |
| 1275090870 | Lags Spine and Sportscare Medical Centers, Inc. | Social Worker | 2651 S C St Ste 200, Oxnard, CA 93033-3560 | 2019-03-01 |
| 1346707114 | Lags Spine and Sportscare Medical Centers, Inc. | Social Worker | 607 Creston Rd, Paso Robles, CA 93446-2775 | 2019-02-27 |
| 1790249894 | Lags Spine and Sportscare Medical Centers, Inc. | Psychologist | 3751 E Shields Avenue, Fresno, CA 93726 | 2019-01-23 |
| 1700357068 | Lags Spine and Sportscare Medical Centers, Inc. | Durable Medical Equipment & Medical Supplies | 3550 Q St Ste 105, Bakersfield, CA 93301-1645 | 2018-12-16 |
| 1689157059 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 801 E Chapel St Ste 6, Santa Maria, CA 93454-4607 | 2018-09-12 |
| 1588147094 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 803 Coffee Rd Ste 11, Modesto, CA 95355-4244 | 2018-09-11 |
| 1992288401 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 1050 Las Tablas Rd Ste 16, Templeton, CA 93465-9480 | 2018-09-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC | 218 North I Street, Lompoc, CA 93436 |
| Washington State Corporations | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. | 11820 Ne Crestwood Dr, Vancouver, WA 98684-5102 |
| Street Address |
11820 NE CRESTWOOD DR STE 100 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98684-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285291849 | Pacifica Sylvan Park LLC | Alzheimer Center (Dementia Center) | 2400 Ne 112th Avenue, Vancouver, WA 98684 | 2019-05-20 |
| 1699242826 | Heidi Ericka Jackson | Registered Nurse | 15606 Ne 12th Way, Vancouver, WA 98684 | 2018-10-25 |
| 1477076727 | Brian Benasa Bardeloza | Dentist | 605 Se 164th Ave Ste 103, Vancouver, WA 98684 | 2017-07-19 |
| 1992226062 | Judith Moreno-castro | Massage Therapist | 2501 Ne 138th Ave., #60, Vancouver, WA 98684 | 2017-06-29 |
| 1346790706 | Samuel Joonsang Lee | Registered Nurse | 501 Se 172nd Ave Ste 210, Vancouver, WA 98684 | 2016-10-10 |
| 1912353178 | Cheryl A. Hamilton-jefferson | Counselor | 11818 Se Mill Plain Blvd Ste 311g, Vancouver, WA 98684 | 2016-05-06 |
| 1063866424 | Kim Forgione | Optometrist | 1900 Ne 162nd Ave Ste D103, Vancouver, WA 98684 | 2016-04-21 |
| 1700254257 | Desiree Haggart | Registered Nurse | 406 Se 131st St., Suite A101, Vancouver, WA 98684 | 2015-09-14 |
| 1215318068 | Paige M. King | Behavioral Analyst | 11818 Se Mill Plain Blvd Ste 203, Vancouver, WA 98684 | 2015-06-17 |
| 1417354366 | Amanda Hilkey, Lmp | Massage Therapist | 108 Se 24th Ave, Ste 9, Vancouver, WA 98684 | 2014-11-20 |
| Find all providers in zip 98684 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215058607 | Matthew James Mcgehee | Physical Medicine & Rehabilitation | 200 Ne Mother Joseph Pl, Ste 110, Vancouver, WA 98664-3299 | 2007-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336511989 | Pain & Wellness Institute, Pllc | Physical Medicine & Rehabilitation | 819 Virginia Street, Unit 1805, Seattle, WA 98101 | 2015-10-22 |
| 1437397361 | Franciscan Medical Group | Physical Medicine & Rehabilitation | 1624 S. I St., Ste 205, Tacoma, WA 98405-5000 | 2009-01-30 |
| 1568635365 | Stephen M Dechter | Physical Medicine & Rehabilitation | 9915 Sandifur Pkwy Ste B, Pasco, WA 99301-8941 | 2008-04-12 |
| 1871777268 | Jason Gene Attaman | Physical Medicine & Rehabilitation | 1600 116th Ave Ne Ste 204, Bellevue, WA 98004-3056 | 2007-12-21 |
| 1003032186 | James A Williams Jr. | Physical Medicine & Rehabilitation | 7401 S Pine St, Suite B, Tacoma, WA 98409-5918 | 2007-04-17 |
| 1326061938 | Richard A Sandler | Physical Medicine & Rehabilitation | 21200 72nd Ave W, Edmonds, WA 98026-7700 | 2006-07-25 |
| 1316978281 | Scott Edward Grosse | Physical Medicine & Rehabilitation | 801 W 5th Ave Ste 323, Spokane, WA 99204-2800 | 2006-07-06 |
| 1184660029 | Jean You | Physical Medicine & Rehabilitation | 6917 W Grandridge Blvd Ste B, Kennewick, WA 99336 | 2006-06-21 |
| 1861486367 | Chan Sun Hwang | Physical Medicine & Rehabilitation | 9312 S Tacoma Way Ste 115, Lakewood, WA 98499-4474 | 2005-09-12 |
| 1386636934 | David L Heard | Physical Medicine & Rehabilitation | 21600 Hwy 99, Suite 255, Edmonds, WA 98026-8012 | 2005-08-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.