Provider Demographics
NPI:1225202674
Name:MEDICAL IMAGING NORTHWEST
Entity Type:Organization
Organization Name:MEDICAL IMAGING NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR EXECUTIVE COMMITTEE
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI-CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-841-4353
Mailing Address - Street 1:1201 PACIFIC AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4301
Mailing Address - Country:US
Mailing Address - Phone:253-841-4353
Mailing Address - Fax:253-583-8630
Practice Address - Street 1:17700 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-372-7040
Practice Address - Fax:253-372-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7817505Medicaid