Provider Demographics
NPI:1821228057
Name:I.G. MEDICAL SUPPLY & PLUS, LLC.
Entity Type:Organization
Organization Name:I.G. MEDICAL SUPPLY & PLUS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERASIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-523-6095
Mailing Address - Street 1:5519 UNIVERSITY WAY NE
Mailing Address - Street 2:STE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3562
Mailing Address - Country:US
Mailing Address - Phone:206-523-6095
Mailing Address - Fax:206-527-6227
Practice Address - Street 1:5519 UNIVERSITY WAY NE
Practice Address - Street 2:STE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3562
Practice Address - Country:US
Practice Address - Phone:206-523-6095
Practice Address - Fax:206-527-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA718862332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies