Provider Demographics
NPI:1962750588
Name:BINA SOURI MD PS
Entity type:Organization
Organization Name:BINA SOURI MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-956-1880
Mailing Address - Street 1:403 BLACK HILLS LN SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8600
Mailing Address - Country:US
Mailing Address - Phone:360-956-1880
Mailing Address - Fax:
Practice Address - Street 1:403 BLACK HILLS LN SW
Practice Address - Street 2:SUITE C
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8600
Practice Address - Country:US
Practice Address - Phone:360-956-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1085190Medicaid
WA1085190Medicaid
WAG001002707Medicare Oscar/Certification