Provider Demographics
NPI:1255354270
Name:OUT REACH MOBILE IMAGING
Entity type:Organization
Organization Name:OUT REACH MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREBILCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS
Authorized Official - Phone:253-921-6613
Mailing Address - Street 1:11012 CANYON RD E
Mailing Address - Street 2:STE 8
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4200
Mailing Address - Country:US
Mailing Address - Phone:253-921-6613
Mailing Address - Fax:253-435-1933
Practice Address - Street 1:11012 CANYON RD E
Practice Address - Street 2:STE 8
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4200
Practice Address - Country:US
Practice Address - Phone:253-921-6613
Practice Address - Fax:253-435-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA196832471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty