Provider Demographics
NPI:1922264035
Name:WASHINGTON PROFESSIONAL MEDICAL SERVICE
Entity Type:Organization
Organization Name:WASHINGTON PROFESSIONAL MEDICAL SERVICE
Other - Org Name:MED STAT HEALTH CARE CORP. EASTSIDE BRANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-372-0322
Mailing Address - Street 1:1060 MOUNT VERNON AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1518
Mailing Address - Country:US
Mailing Address - Phone:614-372-0322
Mailing Address - Fax:614-372-0328
Practice Address - Street 1:1060 MOUNT VERNON AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1518
Practice Address - Country:US
Practice Address - Phone:614-372-0322
Practice Address - Fax:614-372-0328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON PROFESSIONAL MEDICAL SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health