Healthcare Provider Details

I. General information

NPI: 1700152816
Provider Name (Legal Business Name): SEATTLE RADIOLOGISTS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 900
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 900
SEATTLE WA
98104-3586
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberRA60254598
License Number StateWA

VIII. Authorized Official

Name: KAREN LEPPERT
Title or Position: CEO
Credential:
Phone: 206-292-6233