Healthcare Provider Details

I. General information

NPI: 1639653017
Provider Name (Legal Business Name): RADIA IMAGING CENTER HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST STE 900
SEATTLE WA
98104-1391
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 206-292-6233
  • Fax: 206-292-7764
Mailing address:
  • Phone: 425-563-1508
  • 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