Provider Demographics
NPI:1841221389
Name:IRAD MEDICAL IMAGING PC
Entity Type:Organization
Organization Name:IRAD MEDICAL IMAGING PC
Other - Org Name:HIGHLINE RADIOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-248-9729
Mailing Address - Street 1:PO BOX 28036
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-8036
Mailing Address - Country:US
Mailing Address - Phone:877-746-7096
Mailing Address - Fax:559-455-4017
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-248-9729
Practice Address - Fax:206-431-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7052426Medicaid
WA000163700Medicare PIN
WA7052426Medicaid