Basic Information
| Provider Information | |||||||||
| NPI: | 1851580427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON EM-I MEDICAL SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3916 STATE ST | ||||||||
| Address2: | #300 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633010 | ||||||||
| FaxNumber: | 8055645087 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 W 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098653105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 07/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | ISCOVICH | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8055633010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | DD8096 | 01 | WA | RAILROAD | OTHER |