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Stacey Alan Rietze

Anesthesiology

Allopathic & Osteopathic Physicians

104 West 5th Ave, Suite 230e, Spokane, WA 99204-2483

PECOS Enrollment

This provider is enrolled in PECOS as STACEY RIETZE.

Based on the most recent information from CMS, provider Stacey Alan Rietze is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1144235003
Provider Type
Individual
Full Name
Rietze, Stacey Alan
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
7/29/2006
Last Updated
7/8/2007

Contact Information

Practice Location

104 West 5th Ave, Suite 230e, Spokane, WA 99204-2483

(509) 838-8828

(509) 835-4058

Mailing Location

104 West 5th Ave, Suite 230e, Spokane, WA 99204-2483

(509) 838-8828

(509) 835-4058

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License MD00042358 Washington

Provider Identifiers

ID	Description	Issuer
ID 8372658	Description Medicaid	Issuer Unlisted Washington

Stacey Alan Rietze

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Matson, Marcus Christian

Erick, Laureli R

Hepburn, David Stewart Boswell

Henderson, Matthew

Arnett, Jacob T

Hay, John Michael

Cambareri, John J

Moss, Shabnam Majidian

Mckenna, John Joseph

Dhulst, Daniel Matthew