Provider Demographics
NPI:1275081309
Name:INLAND IMAGING LLC - MT
Entity Type:Organization
Organization Name:INLAND IMAGING LLC - MT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-747-4455
Mailing Address - Street 1:801 S STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2654
Mailing Address - Country:US
Mailing Address - Phone:509-747-4455
Mailing Address - Fax:
Practice Address - Street 1:2419 MULLAN RD STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1856
Practice Address - Country:US
Practice Address - Phone:509-747-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID