1144332453 NPI number — WESTERN RADIOLOGY IMAGING LLC

Table of content: (NPI 1144332453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144332453 NPI number — WESTERN RADIOLOGY IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN RADIOLOGY 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:
6
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:
1144332453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24722
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:
98124-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-306-1011
Provider Business Mailing Address Fax Number:
206-306-1019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11011 MERIDIAN AVE N
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-306-1011
Provider Business Practice Location Address Fax Number:
206-306-1019
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANAL
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
206-365-4100

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  UBI 602469354 , 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: 613160100 . This is a "OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 206464 . This is a "GROUP L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7135825 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF0569 . This is a "RR MEDI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7028WE . This is a "REGENCE GROUP#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 602469354 . This is a "UBI#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com