1588904338 NPI number — TRA-MINW, PS

Table of content: (NPI 1588904338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588904338 NPI number — TRA-MINW, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRA-MINW, PS
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:
TACOMA RADIOLOGICAL ASSOCIATES, P.S.
Provider Other Organization Name Type Code:
4
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:
1588904338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-231-9211
Provider Business Mailing Address Fax Number:
800-508-4751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 SE COURT AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-761-4200
Provider Business Practice Location Address Fax Number:
253-383-0730
Provider Enumeration Date:
02/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
EPSHTEYN
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
253-761-4200

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 500663945 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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