Provider Demographics
NPI:1184790032
Name:TRA-MINW P S
Entity type:Organization
Organization Name:TRA-MINW P S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-761-4200
Mailing Address - Street 1:PO BOX 3656
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3656
Mailing Address - Country:US
Mailing Address - Phone:866-231-9211
Mailing Address - Fax:253-761-4201
Practice Address - Street 1:34515 9TH AVE. SOUTH
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-383-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB35572Medicare ID - Type UnspecifiedKING COUNTY