Provider Demographics
NPI:1730112533
Name:1ST MEDICAL LLC
Entity Type:Organization
Organization Name:1ST MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CALE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-302-7220
Mailing Address - Street 1:607 STRANDER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2922
Mailing Address - Country:US
Mailing Address - Phone:206-302-7220
Mailing Address - Fax:206-302-7221
Practice Address - Street 1:607 STRANDER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2922
Practice Address - Country:US
Practice Address - Phone:206-302-7220
Practice Address - Fax:206-302-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60256129211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5750820001Medicare NSC