Provider Demographics
NPI:1336889633
Name:WACN IMAGING LLC
Entity Type:Organization
Organization Name:WACN IMAGING LLC
Other - Org Name:PROFESSIONAL PORTABLE X-RAY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, SEC.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-589-4149
Mailing Address - Street 1:755 CLIFF RD E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1545
Mailing Address - Country:US
Mailing Address - Phone:612-369-1991
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1322
Practice Address - Country:US
Practice Address - Phone:866-895-2119
Practice Address - Fax:952-915-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier