1902013428 NPI number — ISB, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902013428 NPI number — ISB, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISB, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902013428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4306 156TH AVE NE
Provider Second Line Business Mailing Address:
TT-261
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-992-9914
Provider Business Mailing Address Fax Number:
206-501-2102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10056 SE 240TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-992-9914
Provider Business Practice Location Address Fax Number:
206-501-2102
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARLAM
Authorized Official First Name:
ILONA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-992-9914

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0211560 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5981360001 . This is a "DMEPOS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0211559 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0211557 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7133754 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8458416 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8458432 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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