Provider Demographics
NPI:1013920644
Name:PET-CT IMAGING AT SWEDISH CANCER INSTITUTE LLC
Entity Type:Organization
Organization Name:PET-CT IMAGING AT SWEDISH CANCER INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-215-6433
Mailing Address - Street 1:PO BOX 26154
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0154
Mailing Address - Country:US
Mailing Address - Phone:206-215-6433
Mailing Address - Fax:206-215-3066
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:STE 150
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-215-6433
Practice Address - Fax:206-215-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128960Medicaid
WA0200652OtherGROUP L&I
WA7128960Medicaid