Provider Demographics
NPI:1003880923
Name:WASHINGTON IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:WASHINGTON IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-6258
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:STE 260
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-688-0100
Mailing Address - Fax:425-454-8911
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:STE 260
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-688-0100
Practice Address - Fax:425-454-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7078462Medicaid
WACD3334OtherRAILROAD MEDICARE
WA7078462Medicaid