Provider Demographics
NPI:1588761332
Name:JUDYS INTIMATE APPAREL INC
Entity type:Organization
Organization Name:JUDYS INTIMATE APPAREL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-280-7755
Mailing Address - Street 1:2528 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2033
Mailing Address - Country:US
Mailing Address - Phone:360-357-8807
Mailing Address - Fax:360-956-9540
Practice Address - Street 1:2528 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2033
Practice Address - Country:US
Practice Address - Phone:360-357-8807
Practice Address - Fax:360-956-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040JUOtherREGENCE
WA011825001OtherGROUP HEALTH
WA9425000Medicaid
WA9425000Medicaid