Provider Demographics
NPI:1740898766
Name:ABX MEDICAL PLLC
Entity type:Organization
Organization Name:ABX MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AIBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-514-1221
Mailing Address - Street 1:120 STATE AVE NE # 1506
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2523 SIMON LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3553
Practice Address - Country:US
Practice Address - Phone:786-514-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty