1790822070 NPI number — ADVANCED OPEN IMAGING LLC

Table of content: (NPI 1790822070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790822070 NPI number — ADVANCED OPEN IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED OPEN IMAGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790822070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19401 40TH AVE WEST
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-771-8161
Provider Business Mailing Address Fax Number:
425-771-7929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19401 40TH AVE WEST
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-771-8161
Provider Business Practice Location Address Fax Number:
425-771-7929
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MARK
Authorized Official Middle Name:
PARKER
Authorized Official Title or Position:
CO-MANAGER
Authorized Official Telephone Number:
425-771-8161

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA9346 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0170315 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 89349911 . This is a "CRIME VICTIM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7118284 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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