Provider Demographics
NPI:1376612069
Name:TACOMA MAGNETIC IMAGING LP
Entity Type:Organization
Organization Name:TACOMA MAGNETIC IMAGING LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-383-1099
Mailing Address - Street 1:3402 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1903
Mailing Address - Country:US
Mailing Address - Phone:253-383-1099
Mailing Address - Fax:253-383-3919
Practice Address - Street 1:2502 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1328
Practice Address - Country:US
Practice Address - Phone:253-383-1099
Practice Address - Fax:253-383-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOO1056500Medicare ID - Type Unspecified