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General NPI Number Information
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NPI Number | 1407948342
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Entity Type | Organization
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Legal Business Name | MEDILINE PROFESSIONAL SERVICES,INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4407 N DIVISION ST STE 417
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City | SPOKANE
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State | WA
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Zip | 99207-1613
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Country | US
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Telephone | 509-389-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 4407 N DIVISION ST STE 417
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City | SPOKANE
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State | WA
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Zip | 99207-1613
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Country | US
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Telephone | 509-389-9765
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWEN HAROLD AUSTRHEIM
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Credential |
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Telephone | 509-389-9765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | WA
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