Provider Demographics
NPI:1720166895
Name:EXCEL IMAGING LLC
Entity Type:Organization
Organization Name:EXCEL IMAGING LLC
Other - Org Name:SOUTH CENTER IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-412-4423
Mailing Address - Street 1:415 BAKER BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:206-439-8828
Mailing Address - Fax:206-439-8878
Practice Address - Street 1:415 BAKER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-439-8828
Practice Address - Fax:206-439-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119183Medicaid
WAAB39058Medicare ID - Type Unspecified