Healthcare Provider Details

I. General information

NPI: 1588775662
Provider Name (Legal Business Name): LYNDEN MEDICAL X-RAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 HAMMER RD
LYNDEN WA
98264-9530
US

IV. Provider business mailing address

9310 HAMMER RD
LYNDEN WA
98264-9530
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-5419
  • Fax: 360-354-5400
Mailing address:
  • Phone: 360-354-5419
  • Fax: 360-354-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberRT00002493
License Number StateWA

VIII. Authorized Official

Name: MRS. DEANNA B VAN BEEK
Title or Position: OWNER TECHNOLOGIST
Credential: RT
Phone: 360-360-1237