Provider Demographics
NPI:1841386521
Name:ISLAND INTERNAL MEDICINE INC P S
Entity Type:Organization
Organization Name:ISLAND INTERNAL MEDICINE INC P S
Other - Org Name:LACONNER MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-293-4343
Mailing Address - Street 1:912 32ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3473
Mailing Address - Country:US
Mailing Address - Phone:360-293-4343
Mailing Address - Fax:
Practice Address - Street 1:912 32ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3473
Practice Address - Country:US
Practice Address - Phone:360-293-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113889Medicaid
WAGAB33047Medicare ID - Type UnspecifiedGROUP NUMBER