Healthcare Provider Details

I. General information

NPI: 1740993278
Provider Name (Legal Business Name): PROFESSIONAL RECREATION ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 148TH AVE NE
BELLEVUE WA
98007-3120
US

IV. Provider business mailing address

4455 148TH AVE NE
BELLEVUE WA
98007-3120
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-5566
  • Fax:
Mailing address:
  • Phone: 425-885-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE BECKER
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 425-861-6273