Provider Demographics
NPI:1679511240
Name:SPOKANE IMAGING LLC
Entity Type:Organization
Organization Name:SPOKANE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-637-3378
Mailing Address - Street 1:PO BOX 94217
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6517
Mailing Address - Country:US
Mailing Address - Phone:509-747-5191
Mailing Address - Fax:509-473-4992
Practice Address - Street 1:220 E ROWAN AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1202
Practice Address - Country:US
Practice Address - Phone:509-482-4300
Practice Address - Fax:509-482-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8438061Medicaid
WA8438061Medicaid