Healthcare Provider Details

I. General information

NPI: 1932196607
Provider Name (Legal Business Name): RADIA INC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 33RD AVE W SUITE 210
LYNNWOOD WA
98036-4748
US

IV. Provider business mailing address

19020 33RD AVE W SUITE 210
LYNNWOOD WA
98036-4748
US

V. Phone/Fax

Practice location:
  • Phone: 425-563-1500
  • Fax: 425-563-1501
Mailing address:
  • Phone: 425-563-1500
  • Fax: 425-563-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BART P. KEOGH
Title or Position: PRESIDENT
Credential: MD
Phone: 425-563-1500