Provider Demographics
NPI:1114923976
Name:ISIS MEDICAL, INCORPORATED
Entity Type:Organization
Organization Name:ISIS MEDICAL, INCORPORATED
Other - Org Name:ISIS MEDICAL, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-291-6400
Mailing Address - Street 1:1129 MIAMISBURG CENTERVILLE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-4006
Mailing Address - Country:US
Mailing Address - Phone:937-291-6400
Mailing Address - Fax:937-847-8853
Practice Address - Street 1:1129 MIAMISBURG CENTERVILLE RD STE 310
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-4006
Practice Address - Country:US
Practice Address - Phone:937-291-6400
Practice Address - Fax:937-847-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A293D00000X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID02611Medicare ID - Type UnspecifiedIPL