Provider Demographics
NPI:1083911127
Name:PUYALLUP IMAGING CONSULTANTS LLC
Entity Type:Organization
Organization Name:PUYALLUP IMAGING CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-435-5195
Mailing Address - Street 1:12623 MERIDIAN E
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3469
Mailing Address - Country:US
Mailing Address - Phone:253-435-5195
Mailing Address - Fax:
Practice Address - Street 1:12623 MERIDIAN E
Practice Address - Street 2:SUITE A1
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3469
Practice Address - Country:US
Practice Address - Phone:253-435-5195
Practice Address - Fax:253-435-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6030719952085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty