Healthcare Provider Details

I. General information

NPI: 1821097429
Provider Name (Legal Business Name): PUYALLUP RADIOLOGICAL ASSOCS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MERIDIAN SUITE B
PUYALLUP WA
98371-6995
US

IV. Provider business mailing address

800 S MERIDIAN SUITE B
PUYALLUP WA
98371-6995
US

V. Phone/Fax

Practice location:
  • Phone: 253-845-9511
  • Fax: 253-840-3513
Mailing address:
  • Phone: 253-845-9511
  • Fax: 253-840-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: COTY A MCREYNOLDS
Title or Position: BOOKKEEPER
Credential:
Phone: 253-845-9511