Provider Demographics
NPI:1184950842
Name:GRAYS HARBOR CARDIOVASCULAR IMAGING, LLC
Entity type:Organization
Organization Name:GRAYS HARBOR CARDIOVASCULAR IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:LAYBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-533-6447
Mailing Address - Street 1:1020 ANDERSON DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 ANDERSON DR STE 205
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-533-6447
Practice Address - Fax:360-538-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology