Provider Demographics
NPI:1750441614
Name:OLYMPIC MEDICAL IMAGING CONSULTANTS, PLLC
Entity type:Organization
Organization Name:OLYMPIC MEDICAL IMAGING CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLIRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-813-6021
Mailing Address - Street 1:2916 NW BUCKLIN HILL RD. #381
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-813-6021
Mailing Address - Fax:855-249-8011
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 1220
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-337-6500
Practice Address - Fax:360-337-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085R0202X2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000247300Medicare PIN
WA000247300Medicare UPIN