Provider Demographics
NPI:1588600571
Name:ALPHA OMEGA SONOGRAPHY LLC
Entity Type:Organization
Organization Name:ALPHA OMEGA SONOGRAPHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LACASELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-465-2630
Mailing Address - Street 1:12402 N DIVISION ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1930
Mailing Address - Country:US
Mailing Address - Phone:509-465-2679
Mailing Address - Fax:
Practice Address - Street 1:12402 N DIVISION ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1930
Practice Address - Country:US
Practice Address - Phone:509-465-2630
Practice Address - Fax:509-465-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8868531Medicare PIN