Provider Demographics
NPI:1033446802
Name:BELLADONNA BREAST IMAGING CENTER PLLC
Entity Type:Organization
Organization Name:BELLADONNA BREAST IMAGING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ACHESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-846-5527
Mailing Address - Street 1:PO BOX 84064
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8464
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:1810 116TH AVE NE
Practice Address - Street 2:STE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3058
Practice Address - Country:US
Practice Address - Phone:888-846-5527
Practice Address - Fax:607-324-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-15
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000213892085R0202X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty