Provider Demographics
NPI:1447575188
Name:SOUTH SOUND INPATIENT PHYSICIANS
Entity Type:Organization
Organization Name:SOUTH SOUND INPATIENT PHYSICIANS
Other - Org Name:SOUND PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KODJABABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-682-1710
Mailing Address - Street 1:1123 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4303
Mailing Address - Country:US
Mailing Address - Phone:253-682-1710
Mailing Address - Fax:253-284-1881
Practice Address - Street 1:250 HOSPITAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty