Provider Demographics
NPI:1720001092
Name:SCHOCK, ANDREW C (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:SCHOCK
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 1:700 E MANITOBA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3885
Mailing Address - Country:US
Mailing Address - Phone:509-925-6100
Mailing Address - Fax:509-925-7604
Practice Address - Street 1:700 E MANITOBA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-925-6100
Practice Address - Fax:509-925-7604
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003463363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8402836Medicaid