1215990924 NPI number — INHEALTH IMAGING, LLC

Table of content: (NPI 1215990924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215990924 NPI number — INHEALTH IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INHEALTH 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:
1215990924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-0139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-598-3141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20700 BOND RD NE
Provider Second Line Business Practice Location Address:
BLDG B
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-598-3141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENNE
Authorized Official First Name:
MANFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
360-598-3141

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  MD00025231 , 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: 7114325 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com