Provider Demographics
NPI:1366846073
Name:PACIFIC COAST RADIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PACIFIC COAST RADIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-581-8949
Mailing Address - Street 1:205 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1336
Mailing Address - Country:US
Mailing Address - Phone:360-589-2359
Mailing Address - Fax:
Practice Address - Street 1:205 9TH AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1336
Practice Address - Country:US
Practice Address - Phone:360-589-2359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000019752085R0202X
WAOP000023382085R0202X
WAMD603353452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty