Provider Demographics
NPI:1336133644
Name:NUCLEAR MEDICINE SERVICES
Entity Type:Organization
Organization Name:NUCLEAR MEDICINE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ICAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC D
Authorized Official - Phone:509-627-0953
Mailing Address - Street 1:1222 COUNTRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7763
Mailing Address - Country:US
Mailing Address - Phone:509-627-0953
Mailing Address - Fax:509-627-0954
Practice Address - Street 1:520 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5257
Practice Address - Country:US
Practice Address - Phone:509-546-2318
Practice Address - Fax:509-546-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1409408Medicaid
WA7056005Medicaid
0025988OtherL & I
0025988OtherL & I