Healthcare Provider Details

I. General information

NPI: 1588899173
Provider Name (Legal Business Name): DYNAMIC MEDICAL DIAGNOSTIC IMAGING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5038 TACOMA MALL BLVD SUITE C
TACOMA WA
98409-7103
US

IV. Provider business mailing address

5038 TACOMA MALL BLVD SUITE C
TACOMA WA
98409-7103
US

V. Phone/Fax

Practice location:
  • Phone: 253-476-9900
  • Fax: 253-476-0148
Mailing address:
  • Phone: 253-476-9900
  • Fax: 253-476-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number602898875
License Number StateWA

VIII. Authorized Official

Name: DR. PHILIP L LUND
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 253-661-1700