Isis Medical, Incorporated
Organization Active NPI Physiological Laboratory · Miamisburg, OH
NPI 1114923976 · NPPES record last updated Feb 26, 2025
Key facts
- NPI
- 1114923976
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physiological Laboratory 293D00000X
- License
- N/A
- Legal business name
- ISIS MEDICAL, INCORPORATED
- Practice address
- 965 Capstone Cir Ste 420
Miamisburg, OH 45342-1000 - Phone
- (888) 840-6400
- Fax
- (937) 847-8853
- NPI assigned
- Jun 24, 2005
- Organization subpart
- No
Authorized official
- Name
- Colleen Duch
- Title
- Vice President
- Phone
- (937) 291-6400
Practitioners 1
-
Thomas Broderick, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH, IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050928000001 | OH | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 7911932017 | Practice locations: Miamisburg, OH |
| O20190322002192 | IN | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 7911932017 | Practice locations: Richmond, IN |
National Provider Directory
Locations
430 S Congress Ave
Ste B
Delray Beach, FL 33445
Phone (937) 291-6400
119 Garwood Rd
Richmond, IN 47374
Phone (937) 291-6400
6848 Loop Rd
Dayton, OH 45459
Phone (937) 291-6400
965 Capstone Dr
Ste 420
Miamisburg, OH 45342
Phone (888) 840-6400
1129 Miamisburg Centerville Rd
Ste 310
West Carrollton, OH 45449
Phone (937) 291-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physiological Laboratory | 293D00000X | N/A | Yes | |
| Physiological Laboratory | 293D00000X |
Addresses
Primary practice location
965 Capstone Cir Ste 420
Miamisburg, OH 45342-1000
Mailing address
PO Box 4110 Dept 5540
Woburn, MA 01888-4110
Phone (888) 840-6400
Other practice location 1
119 Garwood Rd
Richmond, IN 47374-6031
Phone (937) 291-6400
Other practice location 2
25394 Fish Hatchery Rd
Topeka, IL 61567-9372
Phone (888) 840-6400
Other names
- Isis Medical, Inc.
Other providers in Miamisburg, OH
- Ann Imber
- Inspired Nursing Care, LLC
- Internal Medicine Associates, Inc.
- Internal Medicine Associates, Inc.
- Danna Isaacs
- Miranda Ismail
- Amanda Nicole Jackson
- Bryan John Jacobs
- Sarah E Jacobs
- Prithvi Jami
All providers in Miamisburg, OH · Physiological Laboratory in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.