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NPI Code Detail

MEDICARE: I.G. MEDICAL SUPPLY & PLUS, LLC.

MEDICARE: I.G. MEDICAL SUPPLY & PLUS, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies718862WA

General Provider Information

NPI Number : 1821228057
Entity Type Code : Organization
Provider Name (Legal Business Name) : I.G. MEDICAL SUPPLY & PLUS, LLC.
Provider Business Mailing Address
First Line : 5519 UNIVERSITY WAY NE
Second Line : STE A
City : SEATTLE
State : WA
Zip : 98105-3562
Country : US
Telephone Number : 206-523-6095
Fax Number : 206-527-6227
Provider Business Practice Location Address
First Line : 5519 UNIVERSITY WAY NE
Second Line : STE A
City : SEATTLE
State : WA
Zip : 98105-3562
Country : US
Telephone Number : 206-523-6095
Fax Number : 206-527-6227
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MR. ILYA GERASIMOV
Credential :
Telephone Number : 206-523-6095
Provider Enumeration Date : 07/22/2009
Last Update Date : 07/22/2009

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