Provider Demographics
NPI:1467666701
Name:OBJECTIVE DIAGNOSTICS & RESEARCH PS
Entity Type:Organization
Organization Name:OBJECTIVE DIAGNOSTICS & RESEARCH PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WOODHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-460-7234
Mailing Address - Street 1:4803 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2319
Mailing Address - Country:US
Mailing Address - Phone:253-460-7234
Mailing Address - Fax:
Practice Address - Street 1:4803 CENTER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2319
Practice Address - Country:US
Practice Address - Phone:253-460-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)