Provider Demographics
NPI:1508821422
Name:ELECTRODIAGNOSIS & REHABILITATION ASSOCIATES OF TACOMA, PS
Entity Type:Organization
Organization Name:ELECTRODIAGNOSIS & REHABILITATION ASSOCIATES OF TACOMA, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:253-272-9994
Mailing Address - Street 1:3315 S 23RD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1616
Mailing Address - Country:US
Mailing Address - Phone:253-272-9994
Mailing Address - Fax:253-572-0468
Practice Address - Street 1:3315 S 23RD ST
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1616
Practice Address - Country:US
Practice Address - Phone:253-272-9994
Practice Address - Fax:253-572-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1844505Medicaid
WA143326OtherECFMG
WAMD00019442OtherSTATE LICENSE
WA13694OtherLABOR AND INDUSTRIES
WABS0443577OtherDEA REGISTRATION
WA1844505Medicaid
WA1045402Medicare ID - Type Unspecified