Provider Demographics
NPI:1336323047
Name:NORTHWEST RADIOLOGISTS INC., P.S.
Entity Type:Organization
Organization Name:NORTHWEST RADIOLOGISTS INC., P.S.
Other - Org Name:MT. BAKER PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-788-9004
Mailing Address - Street 1:4029 NORTHWEST AVE
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-733-0430
Mailing Address - Fax:360-594-4012
Practice Address - Street 1:4029 NORTHWEST AVE
Practice Address - Street 2:SUITE 301A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-733-0430
Practice Address - Fax:360-733-0438
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST RADIOLOGISTS INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8904202OtherCRIME VICTIMS PROVIDER #
WA0185434OtherDLI PROVIDER #
WA7122831Medicaid
WA7122831Medicaid