Provider Demographics
NPI:1093750614
Name:VALLEY IMAGING
Entity Type:Organization
Organization Name:VALLEY IMAGING
Other - Org Name:MEMORIAL'S VALLEY IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:COVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-895-0400
Mailing Address - Street 1:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2925
Mailing Address - Country:US
Mailing Address - Phone:509-895-0402
Mailing Address - Fax:509-248-0733
Practice Address - Street 1:314 S 11TH AVE
Practice Address - Street 2:STE B
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3214
Practice Address - Country:US
Practice Address - Phone:509-895-0402
Practice Address - Fax:509-248-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601906252261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7093974Medicaid
WAAB05841Medicare ID - Type Unspecified