Healthcare Provider Details

I. General information

NPI: 1588904338
Provider Name (Legal Business Name): TRA-MINW, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SE COURT AVE DEPARTMENT OF RADIOLOGY
PENDLETON OR
97801-3217
US

IV. Provider business mailing address

PO BOX 3656
SEATTLE WA
98124-3656
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax: 253-383-0730
Mailing address:
  • Phone: 866-231-9211
  • Fax: 800-508-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA EPSHTEYN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 253-761-4200