Provider Demographics
NPI:1518292028
Name:SRS MEDICAL CORP.
Entity Type:Organization
Organization Name:SRS MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-882-1101
Mailing Address - Street 1:8672 154TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3556
Mailing Address - Country:US
Mailing Address - Phone:425-882-1101
Mailing Address - Fax:425-882-1935
Practice Address - Street 1:8672 154TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3556
Practice Address - Country:US
Practice Address - Phone:425-882-1101
Practice Address - Fax:425-882-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies