Provider Demographics
NPI:1407937659
Name:SOAS L.L.C.
Entity Type:Organization
Organization Name:SOAS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYRING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-466-3124
Mailing Address - Street 1:32170 STATE ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3719
Mailing Address - Country:US
Mailing Address - Phone:360-675-6688
Mailing Address - Fax:360-675-1563
Practice Address - Street 1:708 E. MORRIS STREET
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-466-3124
Practice Address - Fax:360-466-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6029045Medicaid
WA6029045Medicaid
WAG8804627Medicare PIN