Ty C Gulstrom, PA- C in Mount Vernon, WA - Physician Assistant

Ty C Gulstrom, PA- C is a Physician Assistant physician based in Mount Vernon, Washington. Ty C Gulstrom is licensed to practice in Washington (license number PA10004348) and his current practice location is 1400 E. Kincaid Street, Mount Vernon, Washington. He can be reached at his office (for appointments etc.) via phone at (360) 428-6434.

NPI number for Ty C Gulstrom is 1558306373 and his current mailing address is 1400 E. Kincaid Street, Attn: Credentialing, Mount Vernon, Washington. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1558306373.

Contact Information

	Ty C Gulstrom, PA- C
	1400 E. Kincaid Street, Mount Vernon, WA 98274-4127
	(360) 428-6434
	(360) 848-4233

Physician's Profile

Full Name	Ty C Gulstrom
Gender	Male
Speciality	Physician Assistant
Location	1400 E. Kincaid Street, Mount Vernon, Washington
Accepts Medicare Assignments	Does not participate in Medicare Program. He may not accept medicare assignment.

NPI Data:

NPI Number: 1558306373
Provider Enumeration Date: 06/17/2006
Last Update Date: 02/18/2015

Medical Identifiers

Medical identifiers for Ty C Gulstrom such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1558306373	NPI	-	NPPES
8386484	Medicaid	WA
3479GU	Other	WA	BSWA
605960012	Other		USDLAB
0216864	Other	WA	LIWA

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	PA10004348 (Washington)	Secondary
363A00000X	Physician Assistant	PA10004348 (Washington)	Primary
363AM0700X	Physician Assistant - Medical	PA10004348 (Washington)	Secondary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ty C Gulstrom is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Ty C Gulstrom, PA- C 1400 E. Kincaid Street, Attn: Credentialing, Mount Vernon, WA 98274-4127 Ph: (360) 428-2500	Ty C Gulstrom, PA- C 1400 E. Kincaid Street, Mount Vernon, WA 98274-4127 Ph: (360) 428-6434

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Ty C Gulstrom, PA- C - Physician Assistant in Mount Vernon, WA