1568427904 NPI number — VALLEY METABOLIC IMAGING LLC

Table of content: (NPI 1568427904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568427904 NPI number — VALLEY METABOLIC IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY METABOLIC 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:
1568427904
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:
11100 NE 8TH ST
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-635-4365
Provider Business Mailing Address Fax Number:
425-637-7535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6121 N THESTA AVE
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-449-2640
Provider Business Practice Location Address Fax Number:
559-432-7020
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
949-631-2221

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  1DTF ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1DTF00300 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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