Provider Demographics
NPI:1407470420
Name:WHIDBEY MEDICAL EQUIPMENT SUPPLY LLC
Entity Type:Organization
Organization Name:WHIDBEY MEDICAL EQUIPMENT SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTABOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-331-6145
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-1237
Mailing Address - Country:US
Mailing Address - Phone:360-320-0372
Mailing Address - Fax:360-331-2225
Practice Address - Street 1:1705 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-320-0372
Practice Address - Fax:360-331-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952549057OtherNPI AS CHIROPRACTOR