KSR Health Care LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KSR HEALTH CARE LLC

Doing business as

Invara Clinic

Practice address

31111 US-2
Sultan, WA 98294

Phone

(360) 953-5250

NPI assigned

Aug 17, 2021

Last updated

Mar 2, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Simeon Roth, PHARMDNPI 1275047599

Title

Ceo

Phone

(360) 953-5250

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Invara Clinic Doing business as

Electronic endpoints 1

Tax ID family

Invara3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• KSR Health Care LLC

  dba Invara

  • Clinic Pharmacy
  • Sultan, WA
  • NPI 1093274458
  NPD tax ID
• KSR Health Care LLC

  dba Invara

  • Long Term Care Pharmacy
  • Sultan, WA
  • NPI 1316577869
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Simeon P Roth, RPH

  • Pharmacist
  • Sultan, WA
  • NPI 1275047599
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1790451292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90",
            "city": "SULTAN",
            "state": "WA",
            "postal_code": "982940090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31111 US-2",
            "city": "SULTAN",
            "state": "WA",
            "postal_code": "98294",
            "telephone_number": "360-953-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSR HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "SIMEON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-953-5250",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2132773",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://signup.azova.com/appointment?tab_action=today",
            "affiliation": "N",
            "address_1": "31111 US-2",
            "city": "Sultan",
            "state": "WA",
            "country_code": "US",
            "postal_code": "98294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Invara Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Invara Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicholas Hakiel, ED.S
• Kathryn Isely
• Rebecca Kmitta, ED.S. NCSP
• KSR Health Care LLC (Invara)
• KSR Health Care LLC (Invara)
• Brandy Lipscomb, ND
• Julie Ann Martinez, LMP
• Michele D Mayatte, ND
• Dana Lynn McCarty, M.ED.
• Barbara Heintz McDaniel, BS, LMP

• Clinic/Center in Sultan, WA
• Providers in Sultan, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.