Provider Demographics
NPI:1174394696
Name:ISCHEMIC INJURED ORGANS AND LIMBS FOUNDATION
Entity type:Organization
Organization Name:ISCHEMIC INJURED ORGANS AND LIMBS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-508-6779
Mailing Address - Street 1:11104 LUND PL
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1623
Mailing Address - Country:US
Mailing Address - Phone:240-508-6779
Mailing Address - Fax:
Practice Address - Street 1:2000 KRAFT DR STE 1208
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6703
Practice Address - Country:US
Practice Address - Phone:540-952-2588
Practice Address - Fax:540-274-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335U00000XSuppliersOrgan Procurement Organization