Provider Demographics
NPI:1679572036
Name:PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CORP
Other - Org Name:PROFESSIONAL MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FRUMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARASOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-366-9543
Mailing Address - Street 1:PO BOX 15112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-0112
Mailing Address - Country:US
Mailing Address - Phone:206-366-9543
Mailing Address - Fax:206-366-9544
Practice Address - Street 1:12733 28TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4321
Practice Address - Country:US
Practice Address - Phone:206-366-9543
Practice Address - Fax:206-366-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9048653Medicaid
WA1218520001Medicare PIN