Provider Demographics
NPI:1265506349
Name:SEATTLE NUCLEAR MEDICINE-ULTRASOUND ASSOCIATES
Entity Type:Organization
Organization Name:SEATTLE NUCLEAR MEDICINE-ULTRASOUND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HASELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-386-6900
Mailing Address - Street 1:PO BOX 84988
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6288
Mailing Address - Country:US
Mailing Address - Phone:206-386-6900
Mailing Address - Fax:206-386-3965
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 1050
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3587
Practice Address - Country:US
Practice Address - Phone:206-386-6900
Practice Address - Fax:206-386-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16301261QR0200X
WA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7061682Medicaid