Healthcare Provider Details

I. General information

NPI: 1033408638
Provider Name (Legal Business Name): SOUTH SOUND INPATIENT PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 OLD MOCKSVILLE RD
STATESVILLE NC
28625-1930
US

IV. Provider business mailing address

1123 PACIFIC AVE
TACOMA WA
98402-4303
US

V. Phone/Fax

Practice location:
  • Phone: 704-873-0281
  • Fax: 704-838-7287
Mailing address:
  • Phone: 253-682-1710
  • Fax: 253-284-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES KODJABABIAN
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 253-682-1710