Provider Demographics
NPI:1407948342
Name:MEDILINE PROFESSIONAL SERVICES,INC
Entity Type:Organization
Organization Name:MEDILINE PROFESSIONAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:AUSTRHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-389-9765
Mailing Address - Street 1:4407 N DIVISION ST STE 417
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1613
Mailing Address - Country:US
Mailing Address - Phone:509-389-9765
Mailing Address - Fax:
Practice Address - Street 1:4407 N DIVISION ST STE 417
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1613
Practice Address - Country:US
Practice Address - Phone:509-389-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory