Healthcare Provider Details

I. General information

NPI: 1871821124
Provider Name (Legal Business Name): IYM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46440 BENEDICT DR SUITE 104
STERLING VA
20164-6602
US

IV. Provider business mailing address

46440 BENEDICT DR SUITE 104
STERLING VA
20164-6602
US

V. Phone/Fax

Practice location:
  • Phone: 571-313-0542
  • Fax: 571-313-0556
Mailing address:
  • Phone: 571-313-0542
  • Fax: 571-313-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: IBTIHAJ AWADELKARIEM
Title or Position: OWNER
Credential: MT
Phone: 571-313-0542