Provider Demographics
NPI:1164459673
Name:HIGHLINE IMAGING LLC
Entity Type:Organization
Organization Name:HIGHLINE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST TO CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-988-5774
Mailing Address - Street 1:PO BOX 94586
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6886
Mailing Address - Country:US
Mailing Address - Phone:206-988-5774
Mailing Address - Fax:206-244-3569
Practice Address - Street 1:275 W 160TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-988-5774
Practice Address - Fax:206-244-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122112Medicaid
WA8801784Medicare PIN
WADB5547Medicare PIN