1932196607 NPI number — RADIA INC P S

Table of content: (NPI 1932196607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932196607 NPI number — RADIA INC P S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIA INC P S
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:
RADIA
Provider Other Organization Name Type Code:
3
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:
1932196607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19020 33RD AVE W
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-563-1500
Provider Business Mailing Address Fax Number:
425-563-1501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19020 33RD AVE W
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-4748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-563-1500
Provider Business Practice Location Address Fax Number:
425-563-1501
Provider Enumeration Date:
09/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KEOGH
Authorized Official First Name:
BART
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-563-1500

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: 7085582 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1021232 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115565 . This is a "GROUP LABOR & IND." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7086796 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8921216 . This is a "GROUP CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8078797 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272517 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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