1821097429 NPI number — PUYALLUP RADIOLOGICAL ASSOCS, INC.

Table of content: (NPI 1821097429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821097429 NPI number — PUYALLUP RADIOLOGICAL ASSOCS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUYALLUP RADIOLOGICAL ASSOCS, 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:
1821097429
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:
800 S MERIDIAN
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98371-6995
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-845-9511
Provider Business Mailing Address Fax Number:
253-840-3513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S MERIDIAN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98371-6995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-845-9511
Provider Business Practice Location Address Fax Number:
253-840-3513
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCREYNOLDS
Authorized Official First Name:
COTY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BOOKKEEPER
Authorized Official Telephone Number:
253-845-9511

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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: 0040900 . This is a "DEPT LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7860307 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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