Provider Demographics
NPI:1689892671
Name:RADIOLOGY ASSOCIATES OF LEWIS COUNTY INC PC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF LEWIS COUNTY INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:REISWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-748-4991
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:981 SOUTH MARKET BLVD LOCATION OFFICE
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-748-4991
Mailing Address - Fax:360-748-7778
Practice Address - Street 1:981 SOUTH MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-748-4991
Practice Address - Fax:360-748-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0076571OtherWA L & I
WA7028483Medicaid