Provider Demographics
NPI:1790822070
Name:ADVANCED OPEN IMAGING LLC
Entity type:Organization
Organization Name:ADVANCED OPEN IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-771-8161
Mailing Address - Street 1:19401 40TH AVE WEST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-771-8161
Mailing Address - Fax:425-771-7929
Practice Address - Street 1:19401 40TH AVE WEST
Practice Address - Street 2:SUITE 140
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-771-8161
Practice Address - Fax:425-771-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADA9346OtherRR MEDICARE
WA0170315OtherL&I
WA89349911OtherCRIME VICTIM
WA7118284Medicaid
WA7118284Medicaid
WA=========OtherREGENCE BLUE SHIELD
WAAB37884Medicare ID - Type Unspecified