Provider Demographics
NPI:1528063153
Name:I'SOT INC
Entity type:Organization
Organization Name:I'SOT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-233-4641
Mailing Address - Street 1:670 COUNTY ROAD 83
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:CA
Mailing Address - Zip Code:96015-9722
Mailing Address - Country:US
Mailing Address - Phone:530-233-4641
Mailing Address - Fax:530-233-4140
Practice Address - Street 1:670 COUNTY ROAD 83
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:CA
Practice Address - Zip Code:96015-9722
Practice Address - Country:US
Practice Address - Phone:530-233-4641
Practice Address - Fax:530-233-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000116261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03888FMedicaid
CAZZZ21128ZOtherMEDICARE PART B
CA053888Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER