Provider Demographics
NPI:1700855574
Name:ROMRIELL, JASON A (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:ROMRIELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2715
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-684363A00000X, 363AS0400X
WAPA10004260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8893ROOtherASURIS NW HEATLH
WA0157290OtherDEPT OF LABOR & INDUSTRIE
WA970024321OtherRR MEDICARE
ID000010145420OtherREGENCE BLUE SHIELD OF ID
ID20003823OtherMEDICARE PTAN
WA379109600OtherOWCP
IDK6484OtherBLUE CROSS OF IDAHO
ID807036200Medicaid
WA8387334Medicaid
WA23795OtherGROUP HEALTH NW
WA8903289OtherCRIME VICTIMS
ID20003823OtherMEDICARE PTAN
WA23795OtherGROUP HEALTH NW