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SELEVERSTOV MEDICAL, P.C.
NPI 1275215972
Internal Medicine in College Place, WA

Active since August 02, 2023CLIA 50D2322413 · Waiver
56 N COLLEGE AVE UNIT 2A, COLLEGE PLACE, WA 99324(097) 300-7285(866) 531-7606 Get Directions Write a Review

NPPES record last updated: January 29, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Seleverstov Medical, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SELEVERSTOV MEDICAL, P.C. (NPI 1275215972), doing business as Heritage Clinic, is a healthcare organization registered as an internal medicine in College Place, Washington and active in the NPI registry since August 2023. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Oleksandr Seleverstov, Owner, as its authorized official.

NPPES Registry Identity

NPI1275215972
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSELEVERSTOV MEDICAL, P.C.
Location Address56 N COLLEGE AVE UNIT 2ACollege Place, WA 99324-1048
Mailing Address146 Thunder Ridge DrWalla Walla, WA 99362-7762 · (518) 801-6446
Phone(097) 300-7285
Fax(866) 531-7606
Organization SubpartNo
Authorized OfficialOleksandr SeleverstovOwner · (518) 801-6446
Enumeration DateAugust 2, 2023
Last NPPES UpdateJanuary 29, 2025
NPPES CertifiedJanuary 29, 2025
✔ NPI 1275215972 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
56 N COLLEGE AVE UNIT 2A, College Place, WA 99324
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Other Names 1

Doing Business AsHeritage Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2322413

Seleverstov Medical PC · College Place, WA
Active · expires Apr 4, 2028
CLIA Number50D2322413
Laboratory TypePhysician Office
Certificate Effective DateApril 21, 2025
Certificate Expiration DateApril 4, 2028
Laboratory DirectorOleksandr Seleverstov
Laboratory Phone(509) 730-0728
Laboratory LocationSeleverstov Medical PC56 N College Ave Unit 2A, College Place, WA 99324
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM E ASHBY M.D.
Internal Medicine
56 N COLLEGE AVE UNIT 2A
COLLEGE PLACE, WA 99324
Walla Walla County (509) 529-4850
DR. OLEKSANDR SELEVERSTOV MD
Internal Medicine
56 N COLLEGE AVE UNIT 2A
COLLEGE PLACE, WA 99324
Walla Walla County (509) 730-0728

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Seleverstov Medical, P.C.'s NPI number?

The NPI number for Seleverstov Medical, P.C. is 1275215972. It was assigned to this organization in the NPPES registry on August 2, 2023. The provider is doing business as Heritage Clinic.

Where is Seleverstov Medical, P.C. located?

Seleverstov Medical, P.C. is located at 56 N College Ave Unit 2A, College Place, WA 99324. The listed phone number is (097) 300-7285.

What is Seleverstov Medical, P.C.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Seleverstov Medical, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2322413) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Seleverstov Medical, P.C. accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Seleverstov Medical, P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Seleverstov Medical, P.C. was last updated on January 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.