Provider Demographics
NPI:1194819086
Name:SOUTH SOUND RADIOLOGY ABERDEEN LLC
Entity Type:Organization
Organization Name:SOUTH SOUND RADIOLOGY ABERDEEN LLC
Other - Org Name:GRAYS HARBOR IMAGING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREMONT
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PARRINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-493-4600
Mailing Address - Street 1:1108 BASICH BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1066
Mailing Address - Country:US
Mailing Address - Phone:360-533-0400
Mailing Address - Fax:360-533-5633
Practice Address - Street 1:1108 BASICH BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1066
Practice Address - Country:US
Practice Address - Phone:360-533-0400
Practice Address - Fax:360-533-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223967OtherLABOR & INDUSTRIES INDUSTRIAL INSURANCE GROUP #
8850475Medicare PIN