Provider Demographics
NPI:1447378583
Name:EVERETT MRI & DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:EVERETT MRI & DIAGNOSTIC CENTER LLC
Other - Org Name:FEDERAL WAY MRI & DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:425-259-7900
Mailing Address - Street 1:3331 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4424
Mailing Address - Country:US
Mailing Address - Phone:425-259-7900
Mailing Address - Fax:425-252-0993
Practice Address - Street 1:3331 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4424
Practice Address - Country:US
Practice Address - Phone:425-259-7900
Practice Address - Fax:425-252-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7091754Medicaid
WAAB07146Medicare ID - Type Unspecified