Healthcare Provider Details

I. General information

NPI: 1528318722
Provider Name (Legal Business Name): PACIFIC RADIOLOGY, INC. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH AVE
PASCO WA
99301-5257
US

IV. Provider business mailing address

PO BOX 743850 DEPT. 40014
ATLANTA GA
30374-3850
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-7704
  • Fax: 813-985-8006
Mailing address:
  • Phone: 813-899-6220
  • Fax: 813-985-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERT L DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 855-292-1401