Provider Demographics
NPI:1336724582
Name:PACIFIC WEST DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:PACIFIC WEST DIAGNOSTIC IMAGING
Other - Org Name:PACIFIC WEST DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-654-0887
Mailing Address - Street 1:P.O BOX 50187
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015
Mailing Address - Country:US
Mailing Address - Phone:425-654-0887
Mailing Address - Fax:425-209-0091
Practice Address - Street 1:12644 INTERURBAN AVE SOUTH,
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168
Practice Address - Country:US
Practice Address - Phone:425-654-0887
Practice Address - Fax:425-209-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty