Provider Demographics
NPI:1043328636
Name:SKAGIT DIGITAL IMAGING LLC
Entity Type:Organization
Organization Name:SKAGIT DIGITAL IMAGING LLC
Other - Org Name:WOMEN'S IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOURNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-428-7212
Mailing Address - Street 1:1320 E DIVISION
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4196
Mailing Address - Country:US
Mailing Address - Phone:360-424-6161
Mailing Address - Fax:360-848-1167
Practice Address - Street 1:1320 E DIVISION
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4196
Practice Address - Country:US
Practice Address - Phone:360-424-6161
Practice Address - Fax:360-848-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12945OtherNONE
WA7016124Medicaid