Provider Demographics
NPI:1346382280
Name:SPOKANE MEDICAL IMAGING INC
Entity Type:Organization
Organization Name:SPOKANE MEDICAL IMAGING INC
Other - Org Name:MOBILE MEDICAL DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERICAL
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-789-5711
Mailing Address - Street 1:217 W CATALDO AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2217
Mailing Address - Country:US
Mailing Address - Phone:509-747-1187
Mailing Address - Fax:509-747-1180
Practice Address - Street 1:801 W 5TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2800
Practice Address - Country:US
Practice Address - Phone:509-747-1187
Practice Address - Fax:509-747-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7006414Medicaid
ID1930050Medicare PIN
WA7006414Medicaid