Provider Demographics
NPI:1689283285
Name:DIRECT IMAGING PC
Entity Type:Organization
Organization Name:DIRECT IMAGING PC
Other - Org Name:DIRECT IMAGING AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATTEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-759-8895
Mailing Address - Street 1:6101 SUMMITVIEW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3028
Mailing Address - Country:US
Mailing Address - Phone:509-902-8857
Mailing Address - Fax:509-902-8855
Practice Address - Street 1:6101 SUMMITVIEW AVE STE 200
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3028
Practice Address - Country:US
Practice Address - Phone:509-902-8857
Practice Address - Fax:509-902-8855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRECT IMAGING PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6890698OtherAETNA
WA426319OtherL&I CLINIC
WAG9016079OtherDI CLINIC PTAN
WAG9024448OtherASC MEDICARE PTAN
WA426319OtherL&I CLINIC