Provider Demographics
NPI:1396814166
Name:TRA-MINW P S
Entity Type:Organization
Organization Name:TRA-MINW P S
Other - Org Name:TACOMA RADIOLOGICAL ASSOCIATES PS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-761-4200
Mailing Address - Street 1:PO BOX 3656
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3656
Mailing Address - Country:US
Mailing Address - Phone:866-231-9211
Mailing Address - Fax:253-761-4201
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:253-761-4200
Practice Address - Fax:253-761-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACR0042OtherRR MEDICARE
WA40700OtherLABOR AND INDUSTRIES/DSHS
WA7820707Medicaid
WAP03231OtherREGENCE BLUE SHIELD
WACR0042OtherRR MEDICARE