Provider Demographics
NPI:1730121047
Name:NORTHWEST CARDIAC AND VASCULAR IMAGING, LLC
Entity Type:Organization
Organization Name:NORTHWEST CARDIAC AND VASCULAR IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-462-0071
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:SUITE 545
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-462-0071
Mailing Address - Fax:509-462-0013
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-462-0071
Practice Address - Fax:509-462-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00057949261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122658Medicaid
WA7122658Medicaid
WAG8802162Medicare PIN