Provider Demographics
NPI:1295915833
Name:ALLSTARS MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:ALLSTARS MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:YURYEVICH
Authorized Official - Last Name:MITYANIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-708-7672
Mailing Address - Street 1:3202 15TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1705
Mailing Address - Country:US
Mailing Address - Phone:206-708-7672
Mailing Address - Fax:206-327-9473
Practice Address - Street 1:3202 15TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1705
Practice Address - Country:US
Practice Address - Phone:206-708-7672
Practice Address - Fax:206-327-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602759959332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6069220001Medicare NSC