Basic Information
| Provider Information | |||||||||
| NPI: | 1275785107 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SOUND INPATIENT PHYSICIANS PLLC | ||||||||
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| OtherOrganizationName: | SOUND INPATIENT PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60000 | ||||||||
| Address2: | FILE 31045 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536821710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094585800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | KODJABABIAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2536821710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 7108889 | 05 | WA | MEDICAID |