Provider Demographics
NPI:1164537239
Name:SOUTH SOUND INPATIENT PHYSICIANS PLLC
Entity Type:Organization
Organization Name:SOUTH SOUND INPATIENT PHYSICIANS PLLC
Other - Org Name:SOUND INPATIENT PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KODJABABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:253-682-1710
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE 31045
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1123 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4303
Practice Address - Country:US
Practice Address - Phone:253-682-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278049Medicaid
WA7108889Medicaid
OR278049Medicaid
MT000085274Medicare PIN
ORR138413Medicare PIN
WAGAB28543Medicare PIN
WA7108889Medicaid