Provider Demographics
NPI:1114923976
Name:ISIS MEDICAL, INCORPORATED
Entity type:Organization
Organization Name:ISIS MEDICAL, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-291-6400
Mailing Address - Street 1:PO BOX 4110 DEPT 5540
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-4110
Mailing Address - Country:US
Mailing Address - Phone:888-840-6400
Mailing Address - Fax:937-847-8853
Practice Address - Street 1:965 CAPSTONE CIR STE 420
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-1000
Practice Address - Country:US
Practice Address - Phone:888-840-6400
Practice Address - Fax:937-847-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
293D00000X
N/A293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID02611Medicare ID - Type UnspecifiedIPL