Healthcare Provider Details

I. General information

NPI: 1063606309
Provider Name (Legal Business Name): BELLEVUE MEDICAL IMAGING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 116TH AVE NE
BELLEVUE WA
98004-3816
US

IV. Provider business mailing address

PO BOX 727
BELLEVUE WA
98009-0727
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-1700
  • Fax: 425-454-0600
Mailing address:
  • Phone: 425-454-1700
  • Fax: 425-454-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number22661
License Number StateWA

VIII. Authorized Official

Name: VALERIE S JOHANSEN
Title or Position: BOOKKEEPER
Credential:
Phone: 425-454-1700