Provider Demographics
NPI:1700928744
Name:SPOKANE RADIOLOGY CONSULTANTS, PS
Entity Type:Organization
Organization Name:SPOKANE RADIOLOGY CONSULTANTS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COCCHIARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-747-1187
Mailing Address - Street 1:801 W 5TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2800
Mailing Address - Country:US
Mailing Address - Phone:509-747-1187
Mailing Address - Fax:509-747-1180
Practice Address - Street 1:801 W 5TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2800
Practice Address - Country:US
Practice Address - Phone:509-747-1187
Practice Address - Fax:509-747-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7008899Medicaid
WA8779088431Medicare ID - Type UnspecifiedPROVIDER NUMBER