Provider Demographics
NPI:1205880713
Name:LONGVIEW RADIOLOGISTS, P.S. INC.
Entity type:Organization
Organization Name:LONGVIEW RADIOLOGISTS, P.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-425-5131
Mailing Address - Street 1:700 LINCOLN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1057
Mailing Address - Country:US
Mailing Address - Phone:360-425-5131
Mailing Address - Fax:360-425-5509
Practice Address - Street 1:700 LINCOLN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-1057
Practice Address - Country:US
Practice Address - Phone:360-425-5131
Practice Address - Fax:360-425-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7839301Medicaid
WACP7616OtherRAILROAD MEDICARE
WA12841OtherLABOR & INDUSTRIES
OR111948OtherOREGON DSHS
WA60010OtherREGENCE BLUE SHIELD
WAG000745500Medicare PIN