1205880713 NPI number — LONGVIEW RADIOLOGISTS, P.S. INC.

Table of content: DR. SUBHASHINI SUBRAMANIAN MBBS (NPI 1043486129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205880713 NPI number — LONGVIEW RADIOLOGISTS, P.S. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONGVIEW RADIOLOGISTS, P.S. INC.
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:
1205880713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 LINCOLN ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
KELSO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98626-1057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-425-5131
Provider Business Mailing Address Fax Number:
360-425-5509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 LINCOLN ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KELSO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98626-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-425-5131
Provider Business Practice Location Address Fax Number:
360-425-5509
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VICARS
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
360-425-5131

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7839301 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP7616 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 12841 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 111948 . This is a "OREGON DSHS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 60010 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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