MEDICARE: BELLINGHAM ADVANCED MEDICAL IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		WA

General Provider Information

NPI Number	:	1730605965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLINGHAM ADVANCED MEDICAL IMAGING LLC

Provider Business Mailing Address
First Line	:	125 N 18TH ST STE C
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-3902
Country	:	US
Telephone Number	:	360-428-7246
Fax Number	:	360-428-7208

Provider Business Practice Location Address
First Line	:	1344 KING ST STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-6215
Country	:	US
Telephone Number	:	360-424-6161
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	MR. MARK S TOURNIE
Credential	:
Telephone Number	:	360-428-7212

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	11/10/2017

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